Provider Demographics
NPI:1104160191
Name:WINITSKY, SAMANTHA HARRIS (MS CCC-SLP/TSSLD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:HARRIS
Last Name:WINITSKY
Suffix:
Gender:F
Credentials:MS CCC-SLP/TSSLD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JACLYN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:323 W 96TH ST
Mailing Address - Street 2:APT 514
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3767 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3827
Practice Address - Country:US
Practice Address - Phone:718-967-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist