Provider Demographics
NPI:1265195333
Name:BALKARAN, SAMANTHA KELLY (RDN, CDN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KELLY
Last Name:BALKARAN
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:KELLY
Other - Last Name:MURDOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CDN
Mailing Address - Street 1:13 LAKE MARIE LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-1231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:292 LONG RIDGE RD STE 206
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1627
Practice Address - Country:US
Practice Address - Phone:203-276-4378
Practice Address - Fax:203-276-4975
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2066133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered