Healthcare Provider Details

I. General information

NPI: 1013623578
Provider Name (Legal Business Name): SAMMANTHA PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 A NORTH MAIN STREET
SUNDERLAND MA
01375
US

IV. Provider business mailing address

187 E RIVER ST
ORANGE MA
01364-1803
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-8717
  • Fax:
Mailing address:
  • Phone: 351-213-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW009994
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: