Provider Demographics
NPI:1770997405
Name:SAMANT, PRIYA (DPM)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:SAMANT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:SAJJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:2208 WHITE MIST DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0118
Mailing Address - Country:US
Mailing Address - Phone:510-579-7797
Mailing Address - Fax:
Practice Address - Street 1:3175 SAINT ROSE PKWY STE 320
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3508
Practice Address - Country:US
Practice Address - Phone:702-997-9833
Practice Address - Fax:702-666-0413
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002544213E00000X
OH003795213ES0103X
NV2039213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty