Healthcare Provider Details

I. General information

NPI: 1972486090
Provider Name (Legal Business Name): ASHLEIGH ABREU RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 CHELTENHAM CT
MALTA NY
12020-3264
US

IV. Provider business mailing address

2302 CHELTENHAM CT
MALTA NY
12020-3264
US

V. Phone/Fax

Practice location:
  • Phone: 518-879-8808
  • Fax:
Mailing address:
  • Phone: 518-879-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86198245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: