Healthcare Provider Details

I. General information

NPI: 1427561554
Provider Name (Legal Business Name): ROSHNIE SAMLAL SPECIAL ED. TEACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2017
Last Update Date: 11/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BURD ST
NYACK NY
10960-3205
US

IV. Provider business mailing address

799 BROOKRIDGE DR APT 2
VALLEY COTTAGE NY
10989-1856
US

V. Phone/Fax

Practice location:
  • Phone: 845-353-2350
  • Fax:
Mailing address:
  • Phone: 845-633-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1770244
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: