Healthcare Provider Details

I. General information

NPI: 1033722939
Provider Name (Legal Business Name): KELLY SAMANTHA SESSA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6034 76TH ST
MIDDLE VILLAGE NY
11379-5228
US

IV. Provider business mailing address

6034 76TH ST
MIDDLE VILLAGE NY
11379-5228
US

V. Phone/Fax

Practice location:
  • Phone: 718-419-3219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number066237
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: