Provider Demographics
NPI:1346910064
Name:CUIFFO, SAMANTHA M (NP)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:M
Last Name:CUIFFO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:M
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 BYRON LN
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4001
Mailing Address - Country:US
Mailing Address - Phone:631-882-7074
Mailing Address - Fax:
Practice Address - Street 1:1320 STONY BROOK RD STE 100
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2222
Practice Address - Country:US
Practice Address - Phone:631-941-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310380363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health