Provider Demographics
NPI:1245853993
Name:MEHLMAN, SAMANTHA PIA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PIA
Last Name:MEHLMAN
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 1:115 W 30TH ST RM 400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4075
Mailing Address - Country:US
Mailing Address - Phone:516-318-1213
Mailing Address - Fax:
Practice Address - Street 1:115 W 30TH ST RM 400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4075
Practice Address - Country:US
Practice Address - Phone:516-318-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682786163WX0200X
NY403158363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology