Provider Demographics
NPI:1053834796
Name:BARONE, SAMANTHA (RD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BARONE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 LINTON BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6600
Mailing Address - Country:US
Mailing Address - Phone:561-500-4673
Mailing Address - Fax:561-495-0026
Practice Address - Street 1:4600 LINTON BLVD STE 250
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6600
Practice Address - Country:US
Practice Address - Phone:561-500-4673
Practice Address - Fax:561-495-0026
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86060268133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB650790816390OtherDRIVERS LISENCE