Healthcare Provider Details

I. General information

NPI: 1497202204
Provider Name (Legal Business Name): SAMANTHA HEMMALA LAL RAMJIT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W SUFFOLK AVE FL 2
CENTRAL ISLIP NY
11722-2156
US

IV. Provider business mailing address

45 W SUFFOLK AVE FL 2
CENTRAL ISLIP NY
11722-2156
US

V. Phone/Fax

Practice location:
  • Phone: 631-582-2228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383583
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number665600
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: