Provider Demographics
NPI:1528313996
Name:ELLIOTT-SAMUELS, DAWN JULETTE
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:JULETTE
Last Name:ELLIOTT-SAMUELS
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 1:80 OLD BOSTON POST RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 OLD BOSTON POST RD
Practice Address - Street 2:UNIT 12
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5358
Practice Address - Country:US
Practice Address - Phone:646-342-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist