Healthcare Provider Details

I. General information

NPI: 1396658167
Provider Name (Legal Business Name): LATHA SATHIYAMOORTHY MS,RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 LIBERTY CT
PARSIPPANY NJ
07054-2629
US

IV. Provider business mailing address

22 LIBERTY CT
PARSIPPANY NJ
07054-2629
US

V. Phone/Fax

Practice location:
  • Phone: 858-829-4700
  • Fax:
Mailing address:
  • Phone: 858-829-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86043326
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number86043326
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: