Provider Demographics
NPI:1942064308
Name:SAMPAIO, JILLIAN (RD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SAMPAIO
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 1:6301 IVY LN STE 410
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-6357
Mailing Address - Country:US
Mailing Address - Phone:240-413-4713
Mailing Address - Fax:301-474-5943
Practice Address - Street 1:6301 IVY LN STE 410
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-6357
Practice Address - Country:US
Practice Address - Phone:240-413-4713
Practice Address - Fax:301-474-5943
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered