Individual
SAMANTHA MALLIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1512 SOUTH ST, 1ST FLOOR, PHILADELPHIA, PA 19146-1636
(267) 239-5637
Mailing address
1512 SOUTH ST, 1ST FLOOR, PHILADELPHIA, PA 19146-1636
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN004752
PA
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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