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General NPI Number Information
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NPI Number | 1659188696
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Entity Type | Individual
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Provider Name | SAMANTHA ROSE SHAY
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Gender | Female
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 300 E MAIN ST STE 2
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City | SMITHTOWN
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State | NY
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Zip | 11787-2900
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Country | US
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Telephone | 631-780-6128
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Fax |
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Provider Business Mailing Address
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Address Line | 14 WILSON AVE
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City | NESCONSET
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State | NY
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Zip | 11767-1937
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Country | US
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Telephone | 631-678-2568
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F352267-01
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License Number State | NY
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