Healthcare Provider Details

I. General information

NPI: 1568287886
Provider Name (Legal Business Name): SAMANTHA DELANO MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 631-394-7321
  • Fax:
Mailing address:
  • Phone: 631-394-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86373371
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number13795
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: