Healthcare Provider Details

I. General information

NPI: 1336812593
Provider Name (Legal Business Name): SAMANTHA GAY LEAHY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LOWER WESTFIELD ROAD
HOLYOKE MA
01040
US

IV. Provider business mailing address

29 AVERY RD
SOMERS CT
06071-1539
US

V. Phone/Fax

Practice location:
  • Phone: 413-536-2393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9805
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN2337692
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: