Provider Demographics
NPI:1114379740
Name:SHOULER, KATHRYN (RDN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SHOULER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:CORBETT-SHOULER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:125 OAKLAND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2130
Mailing Address - Country:US
Mailing Address - Phone:631-686-2551
Mailing Address - Fax:631-686-2552
Practice Address - Street 1:125 OAKLAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2130
Practice Address - Country:US
Practice Address - Phone:631-686-2551
Practice Address - Fax:631-686-2552
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered