Healthcare Provider Details

I. General information

NPI: 1083232805
Provider Name (Legal Business Name): SAMANTHA WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CARMAN RD
DIX HILLS NY
11746-5651
US

IV. Provider business mailing address

20 CHARLOTTE PL
PLAINVIEW NY
11803-5607
US

V. Phone/Fax

Practice location:
  • Phone: 631-549-5580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number031224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: