Provider Demographics
NPI:1700345113
Name:SAMEDY, PANADIANE
Entity Type:Individual
Prefix:
First Name:PANADIANE
Middle Name:
Last Name:SAMEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 N KING ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-3232
Mailing Address - Country:US
Mailing Address - Phone:888-418-2221
Mailing Address - Fax:302-429-5806
Practice Address - Street 1:1224 N KING ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-3232
Practice Address - Country:US
Practice Address - Phone:888-418-2221
Practice Address - Fax:302-429-5806
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL800767387Medicaid