Provider Demographics
NPI:1093082513
Name:FORTUNATO, KAITLYNN MARIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:MARIE
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 HANOVER PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2021
Mailing Address - Country:US
Mailing Address - Phone:301-474-2499
Mailing Address - Fax:301-474-5943
Practice Address - Street 1:7219 HANOVER PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2021
Practice Address - Country:US
Practice Address - Phone:301-474-2499
Practice Address - Fax:301-474-5943
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3254133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered