Healthcare Provider Details

I. General information

NPI: 1144859844
Provider Name (Legal Business Name): SAMANTHA ROSE NOVAK MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA ROSE LORENZO MS, RD, LDN

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 ONYX RD
YORK PA
17408-4472
US

IV. Provider business mailing address

2452 ONYX RD
YORK PA
17408-4472
US

V. Phone/Fax

Practice location:
  • Phone: 814-691-8751
  • Fax:
Mailing address:
  • Phone: 814-691-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005934
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: