Provider Demographics
NPI:1689157448
Name:SCHOLEFIELD, SAMANTHA LYN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYN
Last Name:SCHOLEFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 TUDMAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:NY
Mailing Address - Zip Code:13490-1018
Mailing Address - Country:US
Mailing Address - Phone:315-941-7398
Mailing Address - Fax:
Practice Address - Street 1:101 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1634
Practice Address - Country:US
Practice Address - Phone:315-853-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354233363LF0000X
NY726072-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse