Healthcare Provider Details

I. General information

NPI: 1861575201
Provider Name (Legal Business Name): MS. LESLIE RAND WELSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 E MAIN ST
HUNTINGTON NY
11743-2920
US

IV. Provider business mailing address

226 E MAIN ST
HUNTINGTON NY
11743-2920
US

V. Phone/Fax

Practice location:
  • Phone: 631-549-0610
  • Fax: 631-351-8479
Mailing address:
  • Phone: 631-549-0610
  • Fax: 631-351-8479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number005324-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number005324-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: