Healthcare Provider Details

I. General information

NPI: 1346910064
Provider Name (Legal Business Name): SAMANTHA M CUIFFO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SAMANTHA M WATTS

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 STONY BROOK RD STE 100
STONY BROOK NY
11790-2222
US

IV. Provider business mailing address

25 BYRON LN
ISLIP NY
11751-4001
US

V. Phone/Fax

Practice location:
  • Phone: 631-941-2273
  • Fax:
Mailing address:
  • Phone: 631-882-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: