Provider Demographics
NPI:1609482306
Name:SAMAROO, JESSICA AMELIA (ND)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:AMELIA
Last Name:SAMAROO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SAMAROO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR JESSICA SAMAROO
Mailing Address - Street 1:1700 BROADBRIDGE AVE UNIT C37
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5424
Mailing Address - Country:US
Mailing Address - Phone:718-416-5834
Mailing Address - Fax:
Practice Address - Street 1:1700 BROADBRIDGE AVE UNIT C37
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5424
Practice Address - Country:US
Practice Address - Phone:718-416-5834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath