Provider Demographics
NPI:1871389148
Name:TAYLOR-D'AMBROSIO, SAMUEL HENRY (BSN, RN, MSN, PNP-PC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:HENRY
Last Name:TAYLOR-D'AMBROSIO
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Gender:
Credentials:BSN, RN, MSN, PNP-PC
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Other - Credentials:
Mailing Address - Street 1:677 VANDERBILT AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:646-962-3442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY383726363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics