Individual
MRS. STACI LEAVITT DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
27 MCGOVERN DR, MELVILLE, NY 11747-4258
(516) 433-1456
Mailing address
27 MCGOVERN DR, MELVILLE, NY 11747-4258
(516) 433-1456
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000310-01
NY
133V00000X
Registered Dietitian
00031001
NY
Other
Enumeration date
09/18/2024
Last updated
09/18/2024
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