Individual
SAMANTHA STAVOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1512 SOUTH ST, PHILADELPHIA, PA 19146-1636
(267) 239-5637
Mailing address
10905 KIRBY DR, PHILADELPHIA, PA 19154-4205
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN004879
PA
Other
Enumeration date
09/15/2014
Last updated
09/15/2014
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