Provider Demographics
NPI:1487298295
Name:PRYOR, SAMANTHA JO (ND)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JO
Last Name:PRYOR
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 HOWE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2319
Mailing Address - Country:US
Mailing Address - Phone:203-576-4582
Mailing Address - Fax:
Practice Address - Street 1:60 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-7719
Practice Address - Country:US
Practice Address - Phone:203-576-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT652175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath