Provider Demographics
NPI:1629891692
Name:DEVLIN, KATRINA (RD)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BLUE SLIP APT 26L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-7392
Mailing Address - Country:US
Mailing Address - Phone:845-702-1146
Mailing Address - Fax:
Practice Address - Street 1:2 BLUE SLIP APT 26L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-7392
Practice Address - Country:US
Practice Address - Phone:845-702-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86086293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered