Healthcare Provider Details

I. General information

NPI: 1699013318
Provider Name (Legal Business Name): SAMUELLA OLAYINKA SCOTT PA-C, MSHS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 1ST ST
SAN FRANCISCO CA
94105-2687
US

IV. Provider business mailing address

6406 57TH AVE
RIVERDALE MD
20737-2819
US

V. Phone/Fax

Practice location:
  • Phone: 888-803-3370
  • Fax: 888-803-3331
Mailing address:
  • Phone: 301-704-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC04960
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number56872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: