MEDICARE: MRS. LAILINA S WISOFF RD

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
2	133V00000X	Registered Dietitian	011624-01	NY
3	133V00000X	Registered Dietitian	230-LD	HI

General Provider Information

NPI Number	:	1457481293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAILINA S WISOFF RD

Provider Business Mailing Address
First Line	:	6714 73RD PL # 2
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2527
Country	:	US
Telephone Number	:	303-249-8061
Fax Number	:

Provider Business Practice Location Address
First Line	:	6138 SPEARMINT CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-7010
Country	:	US
Telephone Number	:	303-249-8061
Fax Number	:	833-806-0721

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2025

Similar Medicare Providers

1689872392 — MS. SHAWNA KAY STEWART
Practice Location Address:

400 N BEACH ST
FORT WORTH, TX
76111-7010

Practice Phone: 817-335-1994
Practice Fax: 817-916-4665

1316130123 — DR. LARA MESROB YEGHIASARIAN D.M.D.
Practice Location Address:

7010 MORRISON AVE BLDG 128 , DENTAL ACTIVITY
FORT BENNING, GA
31905-0102

Practice Phone: 706-544-4530
Practice Fax:

1447574025 — MS. BETTY JOYCE PETERSON LCSW
Practice Location Address:

400 N BEACH ST
FORT WORTH, TX
76111-7010

Practice Phone: 817-916-5204
Practice Fax: 817-916-4665

1104190115 — AIDS HEALTHCARE FOUNDATION TEXAS INC
Practice Location Address:

400 N BEACH ST , SUITE 104
FORT WORTH, TX
76111-7010

Practice Phone: 817-831-1750
Practice Fax: 817-831-1753

1154664233 — DR. KYLE STEINEMAN D.C., A.T.C
Practice Location Address:

6633 E STATE BLVD , SUITE 200
FORT WAYNE, IN
46815-7010

Practice Phone: 260-245-0460
Practice Fax: 260-245-0770

1851891667 — DELANEY BAUMANN FNP-C, PMHNP-BC
Practice Location Address:

6633 E STATE BLVD
FORT WAYNE, IN
46815-7010

Practice Phone: 260-900-2339
Practice Fax: 260-231-3374

Directions to “ MRS. LAILINA S WISOFF RD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.