Healthcare Provider Details

I. General information

NPI: 1679482103
Provider Name (Legal Business Name): SAMANTHA PANEBIANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W WALNUT ST
BETHLEHEM PA
18018-5755
US

IV. Provider business mailing address

1488 SAUCON MEADOW CT
BETHLEHEM PA
18015-5232
US

V. Phone/Fax

Practice location:
  • Phone: 914-803-2820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN010309
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: