Provider Demographics
NPI:1427449693
Name:DEVINE, SAMANTHA J (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:DEVINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:J
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:314 E NORTH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4737
Mailing Address - Country:US
Mailing Address - Phone:833-246-7662
Mailing Address - Fax:412-442-2323
Practice Address - Street 1:314 E NORTH AVE FL 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4737
Practice Address - Country:US
Practice Address - Phone:833-246-7662
Practice Address - Fax:412-442-2323
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057441363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant