Provider Demographics
NPI:1447843594
Name:SAMUEL, SCHENEVELYN
Entity type:Individual
Prefix:
First Name:SCHENEVELYN
Middle Name:
Last Name:SAMUEL
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 1:10 SANDALWOOD DR APT 4
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3527
Mailing Address - Country:US
Mailing Address - Phone:610-805-9012
Mailing Address - Fax:
Practice Address - Street 1:10 SANDALWOOD DR APT 4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3527
Practice Address - Country:US
Practice Address - Phone:610-805-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty