Healthcare Provider Details

I. General information

NPI: 1770997405
Provider Name (Legal Business Name): PRIYA SAMANT DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRIYA SAJJA DPM

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 SAINT ROSE PKWY STE 320
HENDERSON NV
89052-3508
US

IV. Provider business mailing address

2208 WHITE MIST DR
LAS VEGAS NV
89134-0118
US

V. Phone/Fax

Practice location:
  • Phone: 702-997-9833
  • Fax: 702-666-0413
Mailing address:
  • Phone: 510-579-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002544
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number003795
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2039
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: