Individual ProviderSasheka Samantha SmithLicensed Practical NurseNursing Service ProvidersPractice Address19 E Avon Dr, Amityville, NY 11701-2023(631) 671-1984PECOS EnrollmentBased on the most recent information from CMS, provider Sasheka Samantha Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1184115487Provider TypeIndividualFull NameSmith, Sasheka SamanthaGenderFemaleSole ProprietorYesEnumeration Date5/22/2018Last Updated5/22/2018Contact InformationPractice LocationPractice Address19 E Avon Dr, Amityville, NY 11701-2023Phone(631) 671-1984FaxUnlisted FaxMailing LocationMailing Address19 E Avon Dr, Amityville, NY 11701-2023PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense326832New York