Provider Demographics
NPI:1902476096
Name:USHEROV, SAMANTHA (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:USHEROV
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 GLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-1345
Mailing Address - Country:US
Mailing Address - Phone:203-818-8899
Mailing Address - Fax:203-857-4694
Practice Address - Street 1:129 GLOVER AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-1345
Practice Address - Country:US
Practice Address - Phone:203-818-8899
Practice Address - Fax:203-857-4694
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner