Provider Demographics
NPI:1174008916
Name:SAMUEL, BLESSY (NP)
Entity Type:Individual
Prefix:
First Name:BLESSY
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SULLIVAN DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1936
Mailing Address - Country:US
Mailing Address - Phone:516-870-9316
Mailing Address - Fax:718-441-6058
Practice Address - Street 1:228 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3618
Practice Address - Country:US
Practice Address - Phone:929-437-6161
Practice Address - Fax:888-501-6628
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342542-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty