Healthcare Provider Details

I. General information

NPI: 1073293700
Provider Name (Legal Business Name): MALIK WAHDAN AYED SAMARDALI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96840 NEBRASKA MEDICAL CENTER
OMAHA NE
68198-6840
US

IV. Provider business mailing address

5120 MAYBERRY ST APT 1218
OMAHA NE
68106-1781
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-5600
  • Fax:
Mailing address:
  • Phone: 304-305-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number37311
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: