Staci Leavitt Mind & Body Inc

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

STACI LEAVITT MIND & BODY INC

Practice address

27 McGovern Dr
Melville, NY 11747-4258

Phone

(516) 433-1456

NPI assigned

Sep 19, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Staci Leavitt Davidson, RDNPI 1346077690

Title

President

Phone

(516) 433-1456

Specialties & licenses 7

Addresses

Other names 1

• Staci Leavitt Mind & Body Inc Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Staci Leavitt Davidson, RD

  • Registered Dietitian
  • Melville, NY
  • NPI 1346077690

  Dietitian, Registered

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1548097819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 MCGOVERN DR",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117474258",
            "telephone_number": "516-433-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 MCGOVERN DR",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117474258",
            "telephone_number": "516-433-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACI LEAVITT MIND & BODY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-19",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "STACI",
        "authorized_official_middle_name": "LEAVITT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-433-1456",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Staci Leavitt Mind & Body Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Registered Dietitian in Melville, NY
• Providers in Melville, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.