MEDICARE: MS. SAMARA BIANCA SPINELLA

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	146D00000X	Personal Emergency Response Attendant	9785	NY
2	390200000X	Student in an Organized Health Care Education/Training Program	9758	NY

General Provider Information

NPI Number	:	1457899254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMARA BIANCA SPINELLA

Provider Business Mailing Address
First Line	:	15 COLUMBUS AVE
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-4902
Country	:	US
Telephone Number	:	631-316-5035
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 COLUMBUS AVE
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-4902
Country	:	US
Telephone Number	:	631-316-5035
Fax Number	:

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

Provider Enumeration Date	:	02/01/2017
Last Update Date	:	02/01/2017

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