Healthcare Provider Details

I. General information

NPI: 1427905298
Provider Name (Legal Business Name): SAMUEL WAKELIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 RESERVOIR RD NW
WASHINGTON DC
20007-2126
US

IV. Provider business mailing address

1420 CENTRE AVE APT 2015
PITTSBURGH PA
15219-3535
US

V. Phone/Fax

Practice location:
  • Phone: 978-549-5568
  • Fax:
Mailing address:
  • Phone: 978-549-5568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: