Provider Demographics
NPI:1124779848
Name:RAHMAAN, SAMIYYA WEVON
Entity type:Individual
Prefix:
First Name:SAMIYYA
Middle Name:WEVON
Last Name:RAHMAAN
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 1:3016 SUNSET HARBOR CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0555
Mailing Address - Country:US
Mailing Address - Phone:702-205-9824
Mailing Address - Fax:
Practice Address - Street 1:3016 SUNSET HARBOR CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0555
Practice Address - Country:US
Practice Address - Phone:702-205-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2105431223Medicaid