Samuel Lee Smith, R.D.

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

License

000491 Issued in CT

Practice address

80 Phoenix Ave
Waterbury, CT 06702-1418

Phone

(203) 756-8021

Fax

(203) 596-9038

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447467378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 MAPLE AVE",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064842131",
            "telephone_number": "203-402-0341",
            "fax_number": "203-402-0341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021418",
            "telephone_number": "203-756-8021",
            "fax_number": "203-596-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SAMUEL",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "R.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "CT",
            "license": "000491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Smith
• Mackenzie Smith, MD
• Michelle Smith, APRN
• Phelese Smith, MD
• Priscilla Smith
• Shenelle Keisha Smith, MSN, CNM, IBCLC
• Tanya Chikira Smith, LMSW
• Tanya L Smith
• SMS Home Care Agency LLC
• SMS Home Care Agency LLC

• Nutrition Education Nutritionist in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Nutrition Education Nutritionist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.