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Individual

SAMANTHA ROBYN LEGAULT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DTR

Contact information

Practice address
222 ROUTE 59, SUITE 304, AIRMONT, NY 10901-5204
(845) 547-2161
Mailing address
7316 COVENTRY CT, RIVERDALE, NJ 07457-1637
(551) 427-5109

Taxonomy

Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
1019268
NJ

Other

Enumeration date
04/09/2014
Last updated
04/09/2014
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