Provider Demographics
NPI:1316578669
Name:DOUGLAS, SAMIA CYRILLE (MS IN TEACHING)
Entity Type:Individual
Prefix:
First Name:SAMIA
Middle Name:CYRILLE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MS IN TEACHING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NASSAU RD APT 2
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1618
Mailing Address - Country:US
Mailing Address - Phone:914-479-2664
Mailing Address - Fax:
Practice Address - Street 1:12 NASSAU RD APT 2
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1618
Practice Address - Country:US
Practice Address - Phone:914-479-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist