Provider Demographics
NPI:1639064827
Name:WHITE, SAMANTHA DENISE (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DENISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 TALMADGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1724
Mailing Address - Country:US
Mailing Address - Phone:203-232-1071
Mailing Address - Fax:
Practice Address - Street 1:5 HIGH RIDGE PARK FL 3
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1326
Practice Address - Country:US
Practice Address - Phone:203-869-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical