Provider Demographics
NPI:1295223899
Name:SAMUDA, RANI-KAI JAMILAH (SPT)
Entity Type:Individual
Prefix:
First Name:RANI-KAI
Middle Name:JAMILAH
Last Name:SAMUDA
Suffix:
Gender:F
Credentials:SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 TOLEDO TER APT 309
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1399
Mailing Address - Country:US
Mailing Address - Phone:352-457-8189
Mailing Address - Fax:
Practice Address - Street 1:4040 FAIRFAX DR STE 202
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1613
Practice Address - Country:US
Practice Address - Phone:703-284-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program