Provider Demographics
NPI:1407401508
Name:O'CONNOR, SAMANTHA NICOLE (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:NICOLE
Other - Last Name:WENDLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:1555 LONG POND ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626
Mailing Address - Country:US
Mailing Address - Phone:585-723-7000
Mailing Address - Fax:
Practice Address - Street 1:1555 LONG POND ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-723-7000
Practice Address - Fax:585-723-7871
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023769363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical