Provider Demographics
NPI:1053828178
Name:SAMAI, MARINDA MULICK (RN)
Entity type:Individual
Prefix:
First Name:MARINDA
Middle Name:MULICK
Last Name:SAMAI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5516
Mailing Address - Country:US
Mailing Address - Phone:917-900-5057
Mailing Address - Fax:
Practice Address - Street 1:66 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5516
Practice Address - Country:US
Practice Address - Phone:917-900-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY743428163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse