Provider Demographics
NPI:1427519826
Name:LEMIEUX, HALEY ELISE SANDERS (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ELISE SANDERS
Last Name:LEMIEUX
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1301
Mailing Address - Country:US
Mailing Address - Phone:802-379-1023
Mailing Address - Fax:
Practice Address - Street 1:227 BOLTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1301
Practice Address - Country:US
Practice Address - Phone:802-379-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4719133V00000X
MALDN6681133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered