Provider Demographics
NPI:1285192609
Name:JEROME, SAMANTHA (RDN, CDCES, LRD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:JEROME
Suffix:
Gender:F
Credentials:RDN, CDCES, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 E CHANDLER BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0303
Mailing Address - Country:US
Mailing Address - Phone:480-264-0119
Mailing Address - Fax:
Practice Address - Street 1:2607 E SILVERWOOD DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-9288
Practice Address - Country:US
Practice Address - Phone:480-264-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered