Provider Demographics
NPI:1558510420
Name:ESSON-SAMUELS, CLAIRE ANITA (RD)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:ANITA
Last Name:ESSON-SAMUELS
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 1:920 CO OP CITY BLVD APT 2J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1648
Mailing Address - Country:US
Mailing Address - Phone:718-671-0278
Mailing Address - Fax:
Practice Address - Street 1:18410 JAMAICA AVE
Practice Address - Street 2:LIFESPIRE INC
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2400
Practice Address - Country:US
Practice Address - Phone:516-455-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0060861133N00000X
894124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist