Provider Demographics
NPI:1669860862
Name:ANDERSON, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ANDERSON
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 1:113 MORRIS ST
Mailing Address - Street 2:APT 3
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1887
Mailing Address - Country:US
Mailing Address - Phone:347-957-1840
Mailing Address - Fax:
Practice Address - Street 1:9 W PROSPECT AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2018
Practice Address - Country:US
Practice Address - Phone:914-699-0022
Practice Address - Fax:914-699-2154
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691976163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse