Provider Demographics
NPI:1194266973
Name:BAILEY, SAMANTHA AMANDA (LPN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:AMANDA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117-35 195TH STREET
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412
Mailing Address - Country:US
Mailing Address - Phone:443-882-0022
Mailing Address - Fax:
Practice Address - Street 1:117-35 195TH STREET
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412
Practice Address - Country:US
Practice Address - Phone:443-882-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327496164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse