Healthcare Provider Details

I. General information

NPI: 1174916878
Provider Name (Legal Business Name): JOSHUA SAMUEL STRAIT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5142 OPC 80 BOX 5217
APO AP
96368-9503
US

IV. Provider business mailing address

18 MDG UNIT 5142 OPC BOX 5217
APO AP
96368-5217
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02005579A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number02005579A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: