Provider Demographics
NPI:1326342148
Name:KALLOO, SAMINA (RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:SAMINA
Middle Name:
Last Name:KALLOO
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19705 DUNTON AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1407
Mailing Address - Country:US
Mailing Address - Phone:516-606-0580
Mailing Address - Fax:
Practice Address - Street 1:19705 DUNTON AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1407
Practice Address - Country:US
Practice Address - Phone:516-606-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006737133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered