Healthcare Provider Details

I. General information

NPI: 1487298295
Provider Name (Legal Business Name): SAMANTHA JO PRYOR ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 LAFAYETTE ST
BRIDGEPORT CT
06604-7719
US

IV. Provider business mailing address

939 HOWE AVE
SHELTON CT
06484-2319
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-4582
  • Fax:
Mailing address:
  • Phone: 203-576-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number652
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: