Samantha Jean-Guillaume Dessources, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

025045-01 Issued in NY

Practice address

4954 Merrick Rd
Massapequa Park, NY 11762

Phone

(516) 308-7255

NPI assigned

Nov 1, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Samantha Jean-Guillaume Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1598309510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4954 MERRICK RD",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "11762",
            "telephone_number": "516-308-7255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4954 MERRICK RD",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "11762",
            "telephone_number": "516-308-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESSOURCES",
        "first_name": "SAMANTHA",
        "middle_name": "JEAN-GUILLAUME",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-01",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "025045-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "JEAN-GUILLAUME",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sean Dellasperanzo, PMHNP
• Stephanie Deluca
• Sharon Denicola
• Erika Leigh Deo, PMHNP-BC
• Shannon Marie Desantis, M.S, OTR/L
• Christina Ann Devivo, LMSW
• Lauren Diamond, MHC
• Suzanna Lynn Diaquoi, R.N.
• Yanira Digiorgio, OTR
• Rose Dioguardi

• Physician Assistant in Massapequa Park, NY
• Providers in Massapequa Park, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.