Provider Demographics
NPI:1609347202
Name:CLARKE, SAMILIA (HAIR LOSS SPT)
Entity Type:Individual
Prefix:
First Name:SAMILIA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:HAIR LOSS SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10543 FLATLANDS 1ST ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3007
Mailing Address - Country:US
Mailing Address - Phone:929-307-9866
Mailing Address - Fax:
Practice Address - Street 1:418 NEW LOTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-6408
Practice Address - Country:US
Practice Address - Phone:929-307-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management