Provider Demographics
NPI:1265841209
Name:BARRACKS, MONEAH SAMANTHA (APN)
Entity Type:Individual
Prefix:MRS
First Name:MONEAH
Middle Name:SAMANTHA
Last Name:BARRACKS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:MONEAH
Other - Middle Name:SAMANTHA
Other - Last Name:CLEMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:3200 BENSALEM BLVD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1956
Mailing Address - Country:US
Mailing Address - Phone:215-752-2370
Mailing Address - Fax:
Practice Address - Street 1:1149 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-6007
Practice Address - Country:US
Practice Address - Phone:718-574-1928
Practice Address - Fax:718-919-2374
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306978-1363LA2200X
NJ26NJ00507700363LA2200X, 363LG0600X
PASP017568363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology