GRACIE-ANN SAMADH ROBERTS (NPI# 1407045917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407045917 |
| Entity Type | Individual |
| Full Name | GRACIE-ANN SAMADH ROBERTS |
| Credential | PHYSICIAN ASSISTANT |
| Practice Address |
439 Port Richmond Ave Staten Island NY 10302-1714 |
| Practice Telephone | 9178301235 |
| Mailing Telephone | 9178301235 |
| Enumeration Date | 2007-10-20 |
| Last Update Date | 2016-08-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 011794 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
439 PORT RICHMOND AVE |
| City | STATEN ISLAND |
| State | NY |
| Zip Code | 10302-1714 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154862506 | Mariana Mussa | Dental Hygienist | 439 Port Richmond Ave, Staten Island, NY 10302-1714 | 2017-03-18 |
| 1669922126 | Tracy Tompkinson | Dental Hygienist | 439 Port Richmond Ave, Staten Island, NY 10302-1714 | 2016-10-09 |
| 1730639378 | Briana Limoncelli | Dental Hygienist | 439 Port Richmond Ave, Staten Island, NY 10302-1714 | 2016-10-06 |
| 1316497969 | Ana Paula Mata | Dental Hygienist | 439 Port Richmond Ave, Staten Island, NY 10302-1714 | 2016-10-06 |
| 1710360854 | Brian Joseph Fernandes | Dentist | 439 Port Richmond Ave, Staten Island, NY 10302-1714 | 2015-07-07 |
| 1952739054 | Community Health Center of Richmond Inc | Clinic/Center | 439 Port Richmond Ave, Staten Island, NY 10302-1714 | 2013-10-29 |
| 1295172401 | Dandline Alexandre | Dentist | 439 Port Richmond Ave, Staten Island, NY 10302-1714 | 2013-05-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306494174 | Denasia Fitch | Student in an Organized Health Care Education/Training Program | 80 Willowbrook Rd, Staten Island, NY 10302 | 2019-08-26 |
| 1548752983 | Lawan Rickenbacker | Counselor | 28 Treadwell Ave, Staten Island, NY 10302 | 2018-06-01 |
| 1275059321 | Omolara Rachael Adediji | Nurse Practitioner | 210 Trantor Place, Apt 1d, Staten Island, NY 10302 | 2017-08-21 |
| 1558893479 | Joseph Wilson | Substance Abuse Rehabilitation Facility | 273 Heberton Avenue, Staten Island, NY 10302 | 2017-03-30 |
| 1902358864 | Natalie Valencia Toney-zubairu | Nurse Practitioner | Community Health Center of Richmond, 235 Port Richmond Ave, Staten Island, NY 10302 | 2016-10-26 |
| 1912453788 | Adewunmi Bankole | Registered Nurse | 124 Nicholas Avenue Apt B, Staten Island, NY 10302 | 2016-08-31 |
| 1154788974 | Eileen Patricia Cameron | Counselor | 263-267 Port Richmond Aveune, Staten Island, NY 10302 | 2016-01-25 |
| 1225468432 | Total Dental Care of Staten Island, P.C. | Dentist | 135 Willowbrook Road, Staten Island, NY 10302 | 2013-11-25 |
| 1760723621 | Si. Senior Lifestyle Center Inc | Clinic/Center | 98 Port Richmond Ave, Staten Island, NY 10302 | 2013-03-01 |
| 1962751255 | Kathleen Gomez-rodriguez | Speech-Language Pathologist | 12 Crystal Ave, Staten Island, NY 10302 | 2012-09-03 |
| Find all providers in zip 10302 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033716238 | Alena Rakhman | Physician Assistant | 4118 Amboy Rd, Staten Island, NY 10308-2318 | 2020-10-01 |
| 1518574078 | Dana Marie Tedesco | Physician Assistant | 403 Kissel Ave, Staten Island, NY 10301-2600 | 2020-09-29 |
| 1275155277 | Nicole Deluzio | Physician Assistant | 332 Brighton St, Staten Island, NY 10307-1708 | 2020-05-12 |
| 1497377667 | Alexandra Ferro | Physician Assistant | 150 Colon Ave, Staten Island, NY 10308-1405 | 2020-05-11 |
| 1083236434 | Marisa Dimare | Physician Assistant | 700 Jewett Ave, Staten Island, NY 10314-2808 | 2020-05-08 |
| 1861013625 | Danielle Alexandra Crespo | Physician Assistant | 8 Reading Ave, Staten Island, NY 10312-2021 | 2020-05-04 |
| 1194359257 | Brandon J Rego | Physician Assistant | 224 Slater Blvd, Staten Island, NY 10305-3241 | 2020-02-27 |
| 1447897210 | Anthony Joseph Lazzaro | Physician Assistant | 14 Luna Cir, Staten Island, NY 10312-6047 | 2019-11-29 |
| 1770127664 | Jocelyn Philip | Physician Assistant | 158 Livingston Ave, Staten Island, NY 10314-5131 | 2019-11-04 |
| 1295379303 | Dhiwya Alex | Physician Assistant | 61 Delafield Pl, Staten Island, NY 10310-1675 | 2019-10-31 |
| Find all providers in STATEN ISLAND | ||||
| City | STATEN ISLAND |
| Zip Code | 10302 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.