Healthcare Provider Details

I. General information

NPI: 1518516764
Provider Name (Legal Business Name): SAMANTHA H BROWN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WOODS AVE
ANNANDALE-ON-HUDSON NY
12504-5000
US

IV. Provider business mailing address

PO BOX 5000
ANNANDALE ON HUDSON NY
12504-5000
US

V. Phone/Fax

Practice location:
  • Phone: 845-758-7694
  • Fax:
Mailing address:
  • Phone: 845-758-7694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: