Provider Demographics
NPI:1710437504
Name:SAMBA, NYEH MABEL (LPN)
Entity Type:Individual
Prefix:MISS
First Name:NYEH
Middle Name:MABEL
Last Name:SAMBA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 BAYCHESTER AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1514
Mailing Address - Country:US
Mailing Address - Phone:347-475-5356
Mailing Address - Fax:
Practice Address - Street 1:3330 BAYCHESTER AVE
Practice Address - Street 2:APT 2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1514
Practice Address - Country:US
Practice Address - Phone:347-475-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326122-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse