Provider Demographics
NPI:1457816886
Name:ZAYAS, SAMANTHA CIARA
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:CIARA
Last Name:ZAYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:ARLEQUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3175 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5700
Mailing Address - Country:US
Mailing Address - Phone:718-829-8239
Mailing Address - Fax:
Practice Address - Street 1:3175 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5700
Practice Address - Country:US
Practice Address - Phone:718-829-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator