Provider Demographics
NPI:1063238442
Name:YOUNG-CHAN, SAMANTHA KASSIDY (AGACNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KASSIDY
Last Name:YOUNG-CHAN
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MARCY LN
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6724
Mailing Address - Country:US
Mailing Address - Phone:917-832-2127
Mailing Address - Fax:
Practice Address - Street 1:55 MARCY LN
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6724
Practice Address - Country:US
Practice Address - Phone:917-832-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433169363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care