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NPI Code Detail

MEDICARE: SAMANTHA DONALD RD

MEDICARE:   SAMANTHA  DONALD  RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1164277315
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA DONALD RD
Provider Business Mailing Address
First Line : 5100 W GENESEE ST
Second Line :
City : CAMILLUS
State : NY
Zip : 13031-2354
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5100 W GENESEE ST
Second Line :
City : CAMILLUS
State : NY
Zip : 13031-2354
Country : US
Telephone Number : 315-460-0802
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2024
Last Update Date : 02/03/2026

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