Provider Demographics
NPI:1811549769
Name:DELAND, SAMANTHA SHANNON (NP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:SHANNON
Last Name:DELAND
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PINEWOOD KNL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4763
Mailing Address - Country:US
Mailing Address - Phone:901-606-5551
Mailing Address - Fax:
Practice Address - Street 1:81 LAKE AVE FL 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1410
Practice Address - Country:US
Practice Address - Phone:585-368-6900
Practice Address - Fax:585-546-5806
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily