Provider Demographics
NPI:1336951615
Name:KAVANDER, SAMANTHA (RDN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KAVANDER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4056
Mailing Address - Country:US
Mailing Address - Phone:440-465-2157
Mailing Address - Fax:
Practice Address - Street 1:1662 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4056
Practice Address - Country:US
Practice Address - Phone:440-465-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD09456133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered