1457866378 NPI number — SAMANTHA A SIRANI RDN, LDN

Table of content: SAMANTHA A SIRANI RDN, LDN (NPI 1457866378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457866378 NPI number — SAMANTHA A SIRANI RDN, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIRANI
Provider First Name:
SAMANTHA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDN, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALESSI
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457866378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 RACCOON FORKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD CHATHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12136-3208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-929-4294
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 CARE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-8639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-581-3084
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  86020932 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 4164 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 010008 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)