Provider Demographics
NPI:1235886243
Name:EPIFANIA, SAMANTHA MARIA
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:MARIA
Last Name:EPIFANIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3130
Mailing Address - Country:US
Mailing Address - Phone:516-672-9122
Mailing Address - Fax:
Practice Address - Street 1:59 ELM AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3130
Practice Address - Country:US
Practice Address - Phone:516-672-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY838113163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse