Healthcare Provider Details

I. General information

NPI: 1750108809
Provider Name (Legal Business Name): SAMANTHA VERRONE PSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 UPPER MINOT RD
POWNAL ME
04069-6106
US

IV. Provider business mailing address

3 UPPER MINOT RD
POWNAL ME
04069-6106
US

V. Phone/Fax

Practice location:
  • Phone: 917-885-4542
  • Fax:
Mailing address:
  • Phone: 917-885-4542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number00
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: