Provider Demographics
NPI:1457866378
Name:SIRANI, SAMANTHA A (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:SIRANI
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:J
Other - Last Name:ALESSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 RACCOON FORKS RD
Mailing Address - Street 2:
Mailing Address - City:OLD CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12136-3208
Mailing Address - Country:US
Mailing Address - Phone:518-929-4294
Mailing Address - Fax:
Practice Address - Street 1:3 CARE LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8639
Practice Address - Country:US
Practice Address - Phone:518-581-3084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86020932133V00000X
MA4164133V00000X
NY010008133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered