Provider Demographics
NPI:1457035099
Name:DEYNA, SAMBA
Entity Type:Individual
Prefix:MR
First Name:SAMBA
Middle Name:
Last Name:DEYNA
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 1:5903 AUTUMN OAK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3535
Mailing Address - Country:US
Mailing Address - Phone:614-377-7302
Mailing Address - Fax:
Practice Address - Street 1:5903 AUTUMN OAK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3535
Practice Address - Country:US
Practice Address - Phone:614-377-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care