Healthcare Provider Details

I. General information

NPI: 1982340105
Provider Name (Legal Business Name): SAMANTHA ANN SKOPARANTZOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA VAN TASSEL

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

70 VINE PL
STAMFORD CT
06905-1922
US

V. Phone/Fax

Practice location:
  • Phone: 978-914-3471
  • Fax:
Mailing address:
  • Phone: 978-914-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029863
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6902
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: