Provider Demographics
NPI:1891331799
Name:COUGHLIN, NATASHA (MS, RD, HHC)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:MS, RD, HHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 COUNTRY CLUB RD W
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-3604
Mailing Address - Country:US
Mailing Address - Phone:917-363-0118
Mailing Address - Fax:
Practice Address - Street 1:499 COUNTRY CLUB RD W
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-3604
Practice Address - Country:US
Practice Address - Phone:917-363-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered