Provider Demographics
NPI:1902781990
Name:NUNES, SAMUEL (RD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:NUNES
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TUTTLE CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1872
Mailing Address - Country:US
Mailing Address - Phone:860-519-4540
Mailing Address - Fax:
Practice Address - Street 1:7 TUTTLE CIR
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-1872
Practice Address - Country:US
Practice Address - Phone:860-519-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59.002962133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered