Provider Demographics
NPI:1689925547
Name:SAMUEL, DWAYNE LLOYD (RN)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:LLOYD
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:470 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-6122
Mailing Address - Country:US
Mailing Address - Phone:917-723-8918
Mailing Address - Fax:855-873-4328
Practice Address - Street 1:53 FAIRMONT ST
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-3403
Practice Address - Country:US
Practice Address - Phone:917-723-8918
Practice Address - Fax:855-873-4328
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY22520078163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health