Provider Demographics
NPI:1821557232
Name:DAMPARE, SALOMEY TAKYIBEA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SALOMEY
Middle Name:TAKYIBEA
Last Name:DAMPARE
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 1:728 E 233RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-3202
Mailing Address - Country:US
Mailing Address - Phone:347-899-8620
Mailing Address - Fax:
Practice Address - Street 1:728 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3202
Practice Address - Country:US
Practice Address - Phone:347-899-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321380164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY830725718Medicaid