Provider Demographics
NPI:1053986737
Name:PRASHAD, SAMANTHA (DACM, LAC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PRASHAD
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7818
Mailing Address - Country:US
Mailing Address - Phone:516-474-7081
Mailing Address - Fax:
Practice Address - Street 1:64 N PARK AVE STE 201
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4123
Practice Address - Country:US
Practice Address - Phone:516-474-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006940171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty