Provider Demographics
NPI:1972751030
Name:SAMEDI, SACHIELLE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SACHIELLE
Middle Name:
Last Name:SAMEDI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 QUAIL RUN RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1170
Mailing Address - Country:US
Mailing Address - Phone:617-447-1217
Mailing Address - Fax:
Practice Address - Street 1:1902 QUAIL RUN RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-1170
Practice Address - Country:US
Practice Address - Phone:617-447-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6827OtherSPEECH LANGAUGE PATH PROFESSIONAL LICENSURE
12026438OtherASHA CCC
NM4905OtherNM STATE LICENSURE