Healthcare Provider Details

I. General information

NPI: 1164339651
Provider Name (Legal Business Name): MS. SAMANTHA JOSEPHINE CALDARERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 E SCRANTON AVE
STATEN ISLAND NY
10308-1327
US

IV. Provider business mailing address

3767 RICHMOND AVE
STATEN ISLAND NY
10312-3827
US

V. Phone/Fax

Practice location:
  • Phone: 347-979-5464
  • Fax:
Mailing address:
  • Phone: 347-979-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: