Healthcare Provider Details

I. General information

NPI: 1083661235
Provider Name (Legal Business Name): DAUNETT SAMUDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW DEPT. OF PEDIATRICS-6 FLOOR
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

2024 GEORGIA AVE NW CRENDENTIALING DEPT -2ND FLOOR
WASHINGTON DC
20001-3027
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-4541
  • Fax:
Mailing address:
  • Phone: 202-865-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN52291
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN522-91
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: