Healthcare Provider Details

I. General information

NPI: 1659981397
Provider Name (Legal Business Name): SAMANTHA MIRIAM SNASHALL RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-6675
  • Fax: 614-366-8166
Mailing address:
  • Phone: 614-366-6675
  • Fax: 614-366-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.09190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: