Healthcare Provider Details

I. General information

NPI: 1083550487
Provider Name (Legal Business Name): SAMANVITA IVATURI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 MERRITT BLVD STE 7
DUNDALK MD
21222-2114
US

IV. Provider business mailing address

35 LEXINGTON RD
MONMOUTH JUNCTION NJ
08852-3084
US

V. Phone/Fax

Practice location:
  • Phone: 410-650-2145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10646
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: