Provider Demographics
NPI:1912673146
Name:DAILY-MALYSA, SAMANTHA JACQUELINE (RD, RDN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JACQUELINE
Last Name:DAILY-MALYSA
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CARL ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2149
Mailing Address - Country:US
Mailing Address - Phone:303-895-0556
Mailing Address - Fax:
Practice Address - Street 1:718 SMYTH RD BLDG 1
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-4098
Practice Address - Country:US
Practice Address - Phone:603-624-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered