Provider Demographics
NPI:1841520434
Name:BRYANT, LEISA A (RD, CDN, CSG)
Entity type:Individual
Prefix:MS
First Name:LEISA
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RD, CDN, CSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4027
Mailing Address - Country:US
Mailing Address - Phone:917-754-2059
Mailing Address - Fax:
Practice Address - Street 1:213 E 42ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4027
Practice Address - Country:US
Practice Address - Phone:917-754-2059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48006838133N00000X
NY840711133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered