Provider Demographics
NPI:1568082527
Name:SAMAROO, NATASHA (BSN RN)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:
Last Name:SAMAROO
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PHYLLIS DR
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2936
Mailing Address - Country:US
Mailing Address - Phone:631-335-5226
Mailing Address - Fax:
Practice Address - Street 1:116 PHYLLIS DR
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2936
Practice Address - Country:US
Practice Address - Phone:631-335-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY668336364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY668336Medicaid