Provider Demographics
NPI:1124614326
Name:YAVOREK, SAMANTHA J (PA)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:J
Last Name:YAVOREK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1507
Mailing Address - Country:US
Mailing Address - Phone:585-272-0700
Mailing Address - Fax:585-272-8340
Practice Address - Street 1:100 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1507
Practice Address - Country:US
Practice Address - Phone:585-272-0700
Practice Address - Fax:585-272-8340
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY027322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program