Active NPI
Samuel Deadwyler III
- Driver
- Brooklyn, NY
National Provider Identifier
1114798758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- 511051614
- Practice address
- 1350 Bedford Ave Apt 3M
Brooklyn, NY 11216-5804 - Phone
- (516) 451-4155
- NPI assigned
- Jan 11, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 511051614 | NY | Primary |
Addresses
Primary practice location
1350 Bedford Ave Apt 3M
Brooklyn, NY 11216-5804
Mailing address
1350 Bedford Ave Apt 3M
Brooklyn, NY 11216-5804
Phone (516) 451-4155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 511051614 | NY | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704931200000",
"number": "1114798758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 BEDFORD AVE APT 3M",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112165804",
"telephone_number": "516-451-4155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 BEDFORD AVE APT 3M",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112165804",
"telephone_number": "516-451-4155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEADWYLER",
"first_name": "SAMUEL",
"name_prefix": "Mr.",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-11",
"last_updated": "2024-01-11",
"certification_date": "2024-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "NY",
"license": "511051614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.