Provider Demographics
NPI:1154812469
Name:NISI, SAMANTHA
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:
Last Name:NISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142-02 20TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11351
Mailing Address - Country:US
Mailing Address - Phone:718-559-0516
Mailing Address - Fax:
Practice Address - Street 1:142-02 20TH AVENUE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11351
Practice Address - Country:US
Practice Address - Phone:718-559-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program