MEDICARE: SYEDA SAMENA ALI NP

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	363LA2200X	Adult Health Nurse Practitioner	H190317	IA
2	363LA2200X	Adult Health Nurse Practitioner	SP035258	PA
3	363LA2200X	Adult Health Nurse Practitioner	310571	NY
4	363LA2200X	Adult Health Nurse Practitioner	LP-0011032	DE

General Provider Information

NPI Number	:	1831857416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYEDA SAMENA ALI NP

Provider Business Mailing Address
First Line	:	2316 BROADWAY
Second Line	:	APT 1R
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4154
Country	:	US
Telephone Number	:	732-585-3335
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 BROADWAY
Second Line	:	APT 1R
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4154
Country	:	US
Telephone Number	:	732-585-3335
Fax Number	:

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

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	04/17/2026

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