Provider Demographics
NPI:1831735380
Name:CARROLL, NATALIE (RDN)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5174 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3416
Mailing Address - Country:US
Mailing Address - Phone:716-574-0803
Mailing Address - Fax:
Practice Address - Street 1:5470 CAMP RD STE 200
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2756
Practice Address - Country:US
Practice Address - Phone:716-646-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009939133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered