Provider Demographics
NPI:1508221615
Name:OSAFO, SAMPSON
Entity Type:Individual
Prefix:
First Name:SAMPSON
Middle Name:
Last Name:OSAFO
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 1:90 MADISON ST STE 404
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2073
Mailing Address - Country:US
Mailing Address - Phone:508-762-9669
Mailing Address - Fax:508-762-9193
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:SUITE 404
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2058
Practice Address - Country:US
Practice Address - Phone:508-762-9669
Practice Address - Fax:508-762-9193
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA471630935251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health