Basic Information
| Provider Information | |||||||||
| NPI: | 1750853065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMASCOTT | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | RD, CDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3050 ROUTE 50 FL 2 | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128662958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188865121 | ||||||||
| FaxNumber: | 5188865857 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 WEST AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128666050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186934699 | ||||||||
| FaxNumber: | 5186934481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2018 | ||||||||
| LastUpdateDate: | 12/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | N | Dietary & Nutritional Service Providers | Nutritionist | 133V00000X | 009189 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.