Provider Demographics
NPI:1023724325
Name:THAI, SAMANTHA STASIA (MS, RDN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:STASIA
Last Name:THAI
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 W MARIE CT
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2884
Mailing Address - Country:US
Mailing Address - Phone:509-727-4172
Mailing Address - Fax:
Practice Address - Street 1:4211 W MARIE CT
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2884
Practice Address - Country:US
Practice Address - Phone:509-727-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered