Provider Demographics
NPI:1659708691
Name:GRILO, SAMANTHA JEAN
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEAN
Last Name:GRILO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 LAUREL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-7643
Mailing Address - Country:US
Mailing Address - Phone:401-316-1766
Mailing Address - Fax:
Practice Address - Street 1:416 LAUREL HILL AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7643
Practice Address - Country:US
Practice Address - Phone:401-316-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-06
Last Update Date:2013-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program