Provider Demographics
NPI:1093019671
Name:SAMUELS, DORIAN (RN)
Entity Type:Individual
Prefix:MS
First Name:DORIAN
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2644
Mailing Address - Country:US
Mailing Address - Phone:917-331-2962
Mailing Address - Fax:
Practice Address - Street 1:642 LOCUST ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2644
Practice Address - Country:US
Practice Address - Phone:917-331-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY441413-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse