Provider Demographics
NPI:1891034104
Name:SAMEDY, MITCHELLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MITCHELLE
Middle Name:
Last Name:SAMEDY
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 1:7 SAND ST
Mailing Address - Street 2:APT 1 A
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1434
Mailing Address - Country:US
Mailing Address - Phone:845-290-7588
Mailing Address - Fax:
Practice Address - Street 1:7 SAND ST
Practice Address - Street 2:APT 1 A
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1434
Practice Address - Country:US
Practice Address - Phone:845-290-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY815023163W00000X
NY312606164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse