Provider Demographics
NPI:1356036321
Name:VILLARI, SAMANTHA ANN (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANN
Last Name:VILLARI
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BRIDLE PASS WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1486
Mailing Address - Country:US
Mailing Address - Phone:513-504-2942
Mailing Address - Fax:
Practice Address - Street 1:3050 MACK RD STE 205
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5376
Practice Address - Country:US
Practice Address - Phone:513-682-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6963133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered