Provider Demographics
NPI:1427922939
Name:FAUTAS, KATHERINE MARGARET (RD, CDN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARGARET
Last Name:FAUTAS
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 OLD TOWN LN
Mailing Address - Street 2:
Mailing Address - City:HALESITE
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2214
Mailing Address - Country:US
Mailing Address - Phone:631-356-8666
Mailing Address - Fax:
Practice Address - Street 1:37 OLD TOWN LN
Practice Address - Street 2:
Practice Address - City:HALESITE
Practice Address - State:NY
Practice Address - Zip Code:11743-2214
Practice Address - Country:US
Practice Address - Phone:631-356-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1020137133V00000X
NY007657133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered