Provider Demographics
NPI:1699013318
Name:SCOTT, SAMUELLA OLAYINKA (PA-C, MSHS, MPH)
Entity Type:Individual
Prefix:MS
First Name:SAMUELLA
Middle Name:OLAYINKA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C, MSHS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 CARROLL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6387
Mailing Address - Country:US
Mailing Address - Phone:301-273-2512
Mailing Address - Fax:
Practice Address - Street 1:7620 CARROLL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6387
Practice Address - Country:US
Practice Address - Phone:301-273-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC04960363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical