Provider Demographics
NPI:1831574755
Name:DEMELLO, SAMANTHA (RD,LD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DEMELLO
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 1:35 OLD SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6225
Mailing Address - Country:US
Mailing Address - Phone:603-682-5855
Mailing Address - Fax:
Practice Address - Street 1:80 PALOMINO LN
Practice Address - Street 2:SUITE 101
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6447
Practice Address - Country:US
Practice Address - Phone:603-518-5859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0771133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered