Provider Demographics
NPI:1225543911
Name:FASANYA, SAMUEL S (A&S SMOOTHRIDE,LLC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:FASANYA
Suffix:
Gender:M
Credentials:A&S SMOOTHRIDE,LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 S HARDIN BLVD STE 110-314
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7736
Mailing Address - Country:US
Mailing Address - Phone:469-782-8220
Mailing Address - Fax:
Practice Address - Street 1:6653 MCKINNEY RANCH PKWY APT 12208
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2225
Practice Address - Country:US
Practice Address - Phone:773-679-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802715611172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver