Healthcare Provider Details

I. General information

NPI: 1679485981
Provider Name (Legal Business Name): SAMIN KHALLAGHI PH.D., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHASE RD STE 203
SCARSDALE NY
10583-4160
US

IV. Provider business mailing address

1 CHASE RD STE 203
SCARSDALE NY
10583-4160
US

V. Phone/Fax

Practice location:
  • Phone: 914-901-3520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number68-P146124-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: