Healthcare Provider Details

I. General information

NPI: 1003487927
Provider Name (Legal Business Name): NATALIYA PUTNAM RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIYA KOROSTENSKY RD

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 KNEELAND RD
NEW HAVEN CT
06512-5006
US

IV. Provider business mailing address

8 PINE GLEN TER
WALLINGFORD CT
06492-2539
US

V. Phone/Fax

Practice location:
  • Phone: 781-315-9185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: