Individual
LESLIE BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 697-3695
(302) 651-4945
Mailing address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 697-3695
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
ND4390
FL
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
ND4390
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016602100
—
FL
Enumeration date
12/31/2014
Last updated
10/05/2016
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