Provider Demographics
NPI:1801527023
Name:FAJARDO-LEGASPI, SAMANTHA JANE (RN, PT)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:JANE
Last Name:FAJARDO-LEGASPI
Suffix:
Gender:F
Credentials:RN, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6459 223RD PL APT 250B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2344
Mailing Address - Country:US
Mailing Address - Phone:917-732-3936
Mailing Address - Fax:
Practice Address - Street 1:18 W END AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1212
Practice Address - Country:US
Practice Address - Phone:917-732-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053201225100000X
NY642748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No163W00000XNursing Service ProvidersRegistered Nurse