Provider Demographics
NPI:1013890417
Name:LEAREY, GWENDOLIN (RDN)
Entity type:Individual
Prefix:
First Name:GWENDOLIN
Middle Name:
Last Name:LEAREY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:FORT MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:10922-0404
Mailing Address - Country:US
Mailing Address - Phone:845-274-7068
Mailing Address - Fax:
Practice Address - Street 1:59 HARBOR ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7361
Practice Address - Country:US
Practice Address - Phone:845-274-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered