Provider Demographics
NPI:1619543725
Name:NJINDA, SAM
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:NJINDA
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 1:21117 CAMOMILE CT # 20876
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6917
Mailing Address - Country:US
Mailing Address - Phone:240-505-4380
Mailing Address - Fax:
Practice Address - Street 1:21117 CAMOMILE CT # 20876
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6917
Practice Address - Country:US
Practice Address - Phone:240-505-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-29
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA15714374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide