Provider Demographics
NPI:1689157448
Name:SCHOLEFIELD, SAMANTHA LYN
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYN
Last Name:SCHOLEFIELD
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 1:5250 TUDMAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:NY
Mailing Address - Zip Code:13490-1018
Mailing Address - Country:US
Mailing Address - Phone:315-941-7398
Mailing Address - Fax:
Practice Address - Street 1:6050 CAVANAUGH RD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-2411
Practice Address - Country:US
Practice Address - Phone:315-941-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726072-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse