Provider Demographics
NPI:1124370010
Name:GRAY, SAMANTHA M (FNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:FNP
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Other - Credentials:
Mailing Address - Street 1:405 SILVERSIDE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1774
Mailing Address - Country:US
Mailing Address - Phone:302-798-0666
Mailing Address - Fax:302-798-2401
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-836-4200
Practice Address - Fax:302-836-8431
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2022-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DELG-0000634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily