Provider Demographics
NPI:1013332030
Name:SAMMY, LALL (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:LALL
Middle Name:
Last Name:SAMMY
Suffix:
Gender:M
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 235TH CT
Mailing Address - Street 2:QUEENS VILLAGE
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2710
Mailing Address - Country:US
Mailing Address - Phone:347-879-5731
Mailing Address - Fax:
Practice Address - Street 1:8660 235TH CT
Practice Address - Street 2:QUEENS VILLAGE
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2710
Practice Address - Country:US
Practice Address - Phone:347-879-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse