Provider Demographics
NPI:1851278055
Name:SIEGEL, SAMANTHA (MPH, RDN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 E W T HARRIS BLVD STE 109
Mailing Address - Street 2:#233
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215
Mailing Address - Country:US
Mailing Address - Phone:727-692-3980
Mailing Address - Fax:
Practice Address - Street 1:5820 E W T HARRIS BLVD STE 109
Practice Address - Street 2:#233
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215
Practice Address - Country:US
Practice Address - Phone:727-692-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86344537133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered