Provider Demographics
NPI:1003691072
Name:KENNEDY, SAMANTHA (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KENNEDY
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Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5151 PARK AVENUE
Mailing Address - Street 2:MASTERS OF PHYSICIAN ASSISTANT STUDIES PROGRAM
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5151 PARK AVE
Practice Address - Street 2:MASTERS OF PHYSICIAN ASSISTANT STUDIES PROGRAM
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825
Practice Address - Country:US
Practice Address - Phone:203-989-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2024-02-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant