Provider Demographics
NPI:1851716070
Name:BLAIR, SAMANTHA CARMEN
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:CARMEN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:CARMEN
Other - Last Name:MASTRELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:365 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14136-1235
Mailing Address - Country:US
Mailing Address - Phone:716-410-1090
Mailing Address - Fax:
Practice Address - Street 1:50 E. NORTH STREEK
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-885-8318
Practice Address - Fax:716-885-0229
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist