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General NPI Number Information
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NPI Number | 1124947056
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Entity Type | Organization
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Legal Business Name | WELLFORM NUTRITION & REGULATORY CONSULTING INC.
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/14/2026
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Provider Practice Location Address
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Address Line | 37 OLD TOWN LN
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City | HALESITE
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State | NY
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Zip | 11743-2214
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Country | US
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Telephone | 631-356-8666
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Fax |
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Provider Business Mailing Address
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Address Line | 37 OLD TOWN LN
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City | HALESITE
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State | NY
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Zip | 11743-2214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE MARGARET FAUTAS
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Credential | RD, CDN
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Telephone | 631-356-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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