Provider Demographics
NPI:1447054747
Name:WUNDROW, LEAH RACHEL (RDN)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:RACHEL
Last Name:WUNDROW
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 HIGHLANDS LAKEVIEW LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-5039
Mailing Address - Country:US
Mailing Address - Phone:317-473-5152
Mailing Address - Fax:
Practice Address - Street 1:5135 HIGHLANDS LAKEVIEW LOOP
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-5039
Practice Address - Country:US
Practice Address - Phone:317-473-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8964133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered