Healthcare Provider Details

I. General information

NPI: 1114861465
Provider Name (Legal Business Name): SAMANTHA DUVALLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 INDUSTRIAL PARK RD UNIT 307
TAUNTON MA
02780-7394
US

IV. Provider business mailing address

101 INDUSTRIAL PARK RD UNIT 307
TAUNTON MA
02780-7394
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-3121
  • Fax:
Mailing address:
  • Phone: 508-880-3121
  • Fax: 508-880-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2345352
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: