Provider Demographics
NPI:1851820450
Name:KATTIRIA, SAMANTHA YSABELLE
Entity type:Individual
Prefix:
First Name:SAMANTHA YSABELLE
Middle Name:
Last Name:KATTIRIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 E HAGGARD AVE
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-8417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:762 E HAGGARD AVE
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-8417
Practice Address - Country:US
Practice Address - Phone:336-278-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033330363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical