MEDICARE: SAMANTHA AYED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor
2	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1649822057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA AYED

Provider Business Mailing Address
First Line	:	2356 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5002
Country	:	US
Telephone Number	:	347-862-8582
Fax Number	:

Provider Business Practice Location Address
First Line	:	2356 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5002
Country	:	US
Telephone Number	:	347-862-8582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	07/15/2019

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