Provider Demographics
NPI:1962018341
Name:SAMB, ABDOU
Entity Type:Individual
Prefix:
First Name:ABDOU
Middle Name:
Last Name:SAMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SORNA DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1453
Mailing Address - Country:US
Mailing Address - Phone:937-660-0115
Mailing Address - Fax:
Practice Address - Street 1:504 SORNA DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1453
Practice Address - Country:US
Practice Address - Phone:937-660-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care