Healthcare Provider Details

I. General information

NPI: 1831569847
Provider Name (Legal Business Name): SAMANTHA SANSONE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BUFFALO ST
HAMBURG NY
14075-5002
US

IV. Provider business mailing address

5853 ONTARIO
OLCOTT NY
14126-9522
US

V. Phone/Fax

Practice location:
  • Phone: 716-648-3120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number029112
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: