Provider Demographics
NPI:1043582026
Name:KEIZE, LELLIETH (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:MS
First Name:LELLIETH
Middle Name:
Last Name:KEIZE
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:MRS
Other - First Name:LELLIETH
Other - Middle Name:
Other - Last Name:LATCHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, CDCES
Mailing Address - Street 1:14 FERRIS AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1538
Mailing Address - Country:US
Mailing Address - Phone:203-952-9715
Mailing Address - Fax:
Practice Address - Street 1:19 OLD KINGS HWY S STE 200
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4532
Practice Address - Country:US
Practice Address - Phone:203-952-3534
Practice Address - Fax:203-803-4697
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT965780133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered