Provider Demographics
NPI:1508471236
Name:SARACENO, SAMANTHA KATE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATE
Last Name:SARACENO
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 1:107 RUMBOLD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4623
Mailing Address - Country:US
Mailing Address - Phone:716-598-1304
Mailing Address - Fax:
Practice Address - Street 1:107 RUMBOLD AVE
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4623
Practice Address - Country:US
Practice Address - Phone:716-598-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY703739-1163WN0002X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care