Healthcare Provider Details

I. General information

NPI: 1457708455
Provider Name (Legal Business Name): SAMANTHA BOYDEN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WASON AVE
SPRINGFIELD MA
01107-1274
US

IV. Provider business mailing address

50 WASON AVE
SPRINGFIELD MA
01107-1274
US

V. Phone/Fax

Practice location:
  • Phone: 413-687-5684
  • Fax:
Mailing address:
  • Phone: 413-794-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1085507
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: