Provider Demographics
NPI:1679264063
Name:SAMURA, SALIEU
Entity Type:Individual
Prefix:
First Name:SALIEU
Middle Name:
Last Name:SAMURA
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 1:6527 BRITANNIC PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2751
Mailing Address - Country:US
Mailing Address - Phone:240-252-8357
Mailing Address - Fax:
Practice Address - Street 1:6527 BRITANNIC PL
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2751
Practice Address - Country:US
Practice Address - Phone:240-252-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities