Individual
DORETTA LAIYING LEUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD/N
Contact information
Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 697-3600
Mailing address
10140 CENTURION PKWY N, JACKSONVILLE, FL 32256-0532
(904) 697-4127
(904) 697-5102
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
ND5672
FL
133V00000X
Registered Dietitian
Primary
ND5672
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024926700
—
FL
Enumeration date
06/07/2010
Last updated
02/21/2019
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