Healthcare Provider Details

I. General information

NPI: 1427679752
Provider Name (Legal Business Name): SAMANTHA JO GRIMALDI MS, RD, CDCES, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST FL 2
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

6092 HEWSON RD
LAKE VIEW NY
14085-9582
US

V. Phone/Fax

Practice location:
  • Phone: 716-440-2351
  • Fax:
Mailing address:
  • Phone: 716-440-2351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: