MEDICARE: SAMAIYAH HARRIS

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	372600000X	Adult Companion
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1821528860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMAIYAH HARRIS

Provider Business Mailing Address
First Line	:	6967 SANDLE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-1884
Country	:	US
Telephone Number	:	904-414-1785
Fax Number	:

Provider Business Practice Location Address
First Line	:	6967 SANDLE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-1884
Country	:	US
Telephone Number	:	904-414-1785
Fax Number	:

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	11/06/2020

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