MEDICARE: MISS KRISTIN ELIZABETH LEONBERG RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND4559	FL

General Provider Information

NPI Number	:	1376609081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KRISTIN ELIZABETH LEONBERG RD, LDN

Provider Business Mailing Address
First Line	:	104 S PRIMROSE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-6335
Country	:	US
Telephone Number	:	724-910-7440
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 N JOHN YOUNG PKWY
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4912
Country	:	US
Telephone Number	:	407-847-4423
Fax Number	:	407-847-5973

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	09/08/2009

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