Provider Demographics
NPI:1457899254
Name:SPINELLA, SAMARA BIANCA
Entity type:Individual
Prefix:MS
First Name:SAMARA
Middle Name:BIANCA
Last Name:SPINELLA
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 1:15 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4902
Mailing Address - Country:US
Mailing Address - Phone:631-316-5035
Mailing Address - Fax:
Practice Address - Street 1:15 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4902
Practice Address - Country:US
Practice Address - Phone:631-316-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9785146D00000X
NY9758390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant