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General NPI Number Information
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NPI Number | 1013772458
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Entity Type | Individual
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Provider Name | SAMANTHA MATTHEWS MS CCC-SLP TSSLD
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Gender | Female
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 2410 N OCEAN AVE STE 202
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City | FARMINGVILLE
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State | NY
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Zip | 11738-2916
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Country | US
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Telephone | 631-346-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 151 HAMILTON AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-3903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 03391901
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License Number State | NY
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