Provider Demographics
NPI:1023310315
Name:LEAHY, CHERI R (RD)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:R
Last Name:LEAHY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:R
Other - Last Name:EDELSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2201 CHAPEL AVE W # WES
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2048
Mailing Address - Country:US
Mailing Address - Phone:856-665-2017
Mailing Address - Fax:856-488-6769
Practice Address - Street 1:42 E LAUREL RD
Practice Address - Street 2:UDP #2500
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-2700
Practice Address - Fax:856-566-6873
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ800882SLRMedicare PIN