Provider Demographics
NPI:1285460923
Name:DESALVO, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DESALVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BLACK HUT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02830-1213
Mailing Address - Country:US
Mailing Address - Phone:401-651-0070
Mailing Address - Fax:
Practice Address - Street 1:123 BLACK HUT RD
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:RI
Practice Address - Zip Code:02830-1213
Practice Address - Country:US
Practice Address - Phone:401-651-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program