Healthcare Provider Details

I. General information

NPI: 1467395640
Provider Name (Legal Business Name): CRISTAL SAMPSON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CENTRAL AVE STE 1
NEW HAVEN CT
06515-2168
US

IV. Provider business mailing address

625 CENTRAL AVE STE 1
NEW HAVEN CT
06515-2168
US

V. Phone/Fax

Practice location:
  • Phone: 203-718-8486
  • Fax: 763-402-7607
Mailing address:
  • Phone: 203-718-8486
  • Fax: 763-402-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRISTAL SAMPSON
Title or Position: OWNER
Credential: RN, APRN, PMHNP-BC
Phone: 347-622-9524