Provider Demographics
NPI:1427679752
Name:GRIMALDI, SAMANTHA JO (MS, RD, CDCES, CDN)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:JO
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:MS, RD, CDCES, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6092 HEWSON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9582
Mailing Address - Country:US
Mailing Address - Phone:716-440-2351
Mailing Address - Fax:
Practice Address - Street 1:1001 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-440-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered