Provider Demographics
NPI:1275312951
Name:SAMELA, KATHERINE ANTOINETTE (MS, RD, CSP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANTOINETTE
Last Name:SAMELA
Suffix:
Gender:F
Credentials:MS, RD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3530
Mailing Address - Country:US
Mailing Address - Phone:203-671-3392
Mailing Address - Fax:888-855-7803
Practice Address - Street 1:500 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3530
Practice Address - Country:US
Practice Address - Phone:203-671-3392
Practice Address - Fax:888-855-7803
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT791133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered