Active NPI
Poornima Samandur
- Registered Dietitian
- West Bloomfield, MI
National Provider Identifier
1578097291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 847864
- Practice address
- 1957 Midchester Dr
West Bloomfield, MI 48324-1164 - Phone
- (248) 682-9220
- NPI assigned
- Apr 19, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 847864 | MI | Primary |
Addresses
Primary practice location
1957 Midchester Dr
West Bloomfield, MI 48324-1164
Mailing address
1957 Midchester Dr
West Bloomfield, MI 48324-1164
Phone (248) 682-9220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505692800000",
"number": "1578097291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1957 MIDCHESTER DR",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483241164",
"telephone_number": "248-682-9220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1957 MIDCHESTER DR",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483241164",
"telephone_number": "248-682-9220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMANDUR",
"first_name": "POORNIMA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-19",
"last_updated": "2017-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MI",
"license": "847864",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.