Provider Demographics
NPI:1932829512
Name:SMITH, SAMANTHA ONEKA (MA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ONEKA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 ATKINS AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4295
Mailing Address - Country:US
Mailing Address - Phone:917-651-6910
Mailing Address - Fax:
Practice Address - Street 1:6143 186TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2710
Practice Address - Country:US
Practice Address - Phone:929-200-7105
Practice Address - Fax:516-324-8785
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist