Healthcare Provider Details

I. General information

NPI: 1811802747
Provider Name (Legal Business Name): SAMANTHA BURCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 AVERY RD
ILION NY
13357-4408
US

IV. Provider business mailing address

311 AVERY RD
ILION NY
13357-4408
US

V. Phone/Fax

Practice location:
  • Phone: 315-240-3191
  • Fax:
Mailing address:
  • Phone: 315-240-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number357561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: