MEDICARE: MRS. MICHAELA SAMUELLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	3969	DC
2	2084P0804X	Child & Adolescent Psychiatry Physician	110242	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740365154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHAELA SAMUELLY MD

Provider Business Mailing Address
First Line	:	928 ALBEMARLE RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-2706
Country	:	US
Telephone Number	:	718-693-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	928 ALBEMARLE RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-2706
Country	:	US
Telephone Number	:	718-462-5480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/11/2025

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