Provider Demographics
NPI:1427287978
Name:MCLEAN, KELLIE (MPH, RD, CDN)
Entity type:Individual
Prefix:MISS
First Name:KELLIE
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MPH, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 27
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-5537
Mailing Address - Country:US
Mailing Address - Phone:914-793-3900
Mailing Address - Fax:914-793-3922
Practice Address - Street 1:475 WHITE PLAINS RD
Practice Address - Street 2:SUITE 27
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-5537
Practice Address - Country:US
Practice Address - Phone:914-793-3900
Practice Address - Fax:914-793-3922
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007324133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007324OtherLICENSE