Provider Demographics
NPI:1659610756
Name:ROBERTELLO, NATALIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:ROBERTELLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:PECKHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 FAIRCHILD DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3327
Mailing Address - Country:US
Mailing Address - Phone:315-368-3181
Mailing Address - Fax:
Practice Address - Street 1:3380 SHERIDAN DR # 317
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1439
Practice Address - Country:US
Practice Address - Phone:716-249-2644
Practice Address - Fax:716-242-0030
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007501133V00000X
NY01043134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered