Provider Demographics
NPI:1275250987
Name:WINGFIELD, SAMUEL PHILLIP
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PHILLIP
Last Name:WINGFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24251 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1454
Mailing Address - Country:US
Mailing Address - Phone:216-780-5897
Mailing Address - Fax:
Practice Address - Street 1:24251 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1454
Practice Address - Country:US
Practice Address - Phone:216-780-5897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications