Healthcare Provider Details

I. General information

NPI: 1326342148
Provider Name (Legal Business Name): SAMINA KALLOO R.D., C.D.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2011
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FAITH LN
ARDSLEY NY
10502-2510
US

IV. Provider business mailing address

7 FAITH LN
ARDSLEY NY
10502-2510
US

V. Phone/Fax

Practice location:
  • Phone: 516-606-0580
  • Fax:
Mailing address:
  • Phone: 516-606-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number006737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: