Healthcare Provider Details

I. General information

NPI: 1184021495
Provider Name (Legal Business Name): SAMANTHA ANNE ZITO MS, RDN , LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 PAULSEN ST
SAVANNAH GA
31405
US

IV. Provider business mailing address

836 E. 65TH STREET SUITE 22
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-3944
  • Fax: 912-819-3943
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1295
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1077074
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD005821
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: