Provider Demographics
NPI:1144828047
Name:LEONE, KELSEY (RD, CDCES)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:LEONE
Suffix:
Gender:F
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 S MIDDLETOWN RD APT 2
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2644
Mailing Address - Country:US
Mailing Address - Phone:845-548-2147
Mailing Address - Fax:
Practice Address - Street 1:584 BABBLING BROOK LN
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1502
Practice Address - Country:US
Practice Address - Phone:845-548-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1092583133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered