Provider Demographics
NPI:1144428640
Name:HUNTLEY, SAMANTHA YVONNE (ETC)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:YVONNE
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1866
Mailing Address - Country:US
Mailing Address - Phone:919-599-6525
Mailing Address - Fax:
Practice Address - Street 1:2617 DURHAM CHAPEL HILL BLVD STE 6
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-599-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC427481744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management