Provider Demographics
NPI:1245828763
Name:ADESANYA, NATALIE (LIFE COACH,NUTRITION)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:ADESANYA
Suffix:
Gender:F
Credentials:LIFE COACH,NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 W SAINT GEORGES AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-6167
Mailing Address - Country:US
Mailing Address - Phone:908-446-9208
Mailing Address - Fax:
Practice Address - Street 1:1203 W SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-6167
Practice Address - Country:US
Practice Address - Phone:908-446-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP1600X
101YP1600X, 225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty