MEDICARE: SAMANTHA LEONE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	640536	NY

General Provider Information

NPI Number	:	1235770710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LEONE RN

Provider Business Mailing Address
First Line	:	94 REDWOOD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-1860
Country	:	US
Telephone Number	:	348-443-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 REDWOOD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-1860
Country	:	US
Telephone Number	:	348-443-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2019
Last Update Date	:	10/04/2019

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Directions to “ SAMANTHA LEONE RN” Practice Location

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