Provider Demographics
NPI:1689014292
Name:SAMAD, WYLENE BARTON (NP)
Entity Type:Individual
Prefix:
First Name:WYLENE
Middle Name:BARTON
Last Name:SAMAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WYLENE
Other - Middle Name:
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1350 GREENE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4902
Mailing Address - Country:US
Mailing Address - Phone:718-628-1407
Mailing Address - Fax:
Practice Address - Street 1:1350 GREENE AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4902
Practice Address - Country:US
Practice Address - Phone:718-628-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339305-1363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily