Provider Demographics
NPI:1912546110
Name:SAMURA, SATTA YONDAY (FNP)
Entity Type:Individual
Prefix:
First Name:SATTA
Middle Name:YONDAY
Last Name:SAMURA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20529 LOWFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2817
Mailing Address - Country:US
Mailing Address - Phone:301-806-7580
Mailing Address - Fax:
Practice Address - Street 1:3521 BUCKEYSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:BUCKEYSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21717-1006
Practice Address - Country:US
Practice Address - Phone:240-215-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty