Provider Demographics
NPI:1871060632
Name:KITSON, SAMANTHA
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:KITSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:PAMLANYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1955
Mailing Address - Country:US
Mailing Address - Phone:631-291-0921
Mailing Address - Fax:
Practice Address - Street 1:4 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1955
Practice Address - Country:US
Practice Address - Phone:631-291-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist