MEDICARE: MIRIAM SAMEKHOVA

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	363LF0000X	Family Nurse Practitioner	352774	NY

General Provider Information

NPI Number	:	1659144186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM SAMEKHOVA

Provider Business Mailing Address
First Line	:	8542 116TH ST
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-1711
Country	:	US
Telephone Number	:	347-730-8201
Fax Number	:

Provider Business Practice Location Address
First Line	:	11956 METROPOLITAN AVE
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2606
Country	:	US
Telephone Number	:	347-730-8201
Fax Number	:	929-335-2526

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

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	05/20/2026

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Directions to “ MIRIAM SAMEKHOVA ” Practice Location

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