Provider Demographics
NPI:1629549308
Name:SAMSUNDAR, NARISHA D (OTR)
Entity Type:Individual
Prefix:
First Name:NARISHA
Middle Name:D
Last Name:SAMSUNDAR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 115TH ST APT B6
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1701
Mailing Address - Country:US
Mailing Address - Phone:347-666-0069
Mailing Address - Fax:
Practice Address - Street 1:8555 115TH ST APT B6
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1701
Practice Address - Country:US
Practice Address - Phone:347-666-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022914225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist