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General NPI Number Information
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NPI Number | 1912651803
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Entity Type | Individual
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Provider Name | LEAH M PASQUARELLA RD CDN
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Gender | Female
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 35 ONTARIO ST
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City | PORT JEFF STA
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State | NY
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Zip | 11776-4345
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Country | US
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Telephone | 631-655-6205
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Fax |
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Provider Business Mailing Address
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Address Line | 35 ONTARIO ST
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City | PORT JEFF STA
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State | NY
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Zip | 11776-4345
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Country | US
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Telephone | 631-655-6205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 006867-01
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License Number State | NY
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