Healthcare Provider Details

I. General information

NPI: 1467375949
Provider Name (Legal Business Name): SAMANTHA MARIE OBERDORF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4418 RIDGE RD STE 1
WILLIAMSON NY
14589-9306
US

IV. Provider business mailing address

3358 SHERIDAN RD
MARION NY
14505-9426
US

V. Phone/Fax

Practice location:
  • Phone: 315-589-4641
  • Fax:
Mailing address:
  • Phone: 315-576-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3082288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: