Healthcare Provider Details

I. General information

NPI: 1508533951
Provider Name (Legal Business Name): SAMANTHA DAWN HERMAN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA DAWN ACHONYE

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 HOOSICK ST STE 100
TROY NY
12180-2450
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-272-0232
  • Fax: 518-274-4083
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: