Provider Demographics
NPI:1629365986
Name:LYNCH, SAMANTHA LEIGH (MS, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 4TH AVE
Mailing Address - Street 2:APT 6J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4900
Mailing Address - Country:US
Mailing Address - Phone:917-626-5496
Mailing Address - Fax:
Practice Address - Street 1:115 4TH AVE
Practice Address - Street 2:APT 6J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4900
Practice Address - Country:US
Practice Address - Phone:917-626-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00988479133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered