Healthcare Provider Details

I. General information

NPI: 1487592101
Provider Name (Legal Business Name): SHERRYE PATRICIA SAMUELS DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 HARPER AVE
BRONX NY
10466-2403
US

IV. Provider business mailing address

4043 HARPER AVE
BRONX NY
10466-2403
US

V. Phone/Fax

Practice location:
  • Phone: 917-834-3110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number344289
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: