Healthcare Provider Details

I. General information

NPI: 1497675482
Provider Name (Legal Business Name): SAMIAH MAHMUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CHESTNUT ST # A
CORAM NY
11727-1406
US

IV. Provider business mailing address

42 CHESTNUT ST # A
CORAM NY
11727-1406
US

V. Phone/Fax

Practice location:
  • Phone: 347-659-8836
  • Fax:
Mailing address:
  • Phone: 347-659-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number945496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: