Shady Samuel

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

055773 Issued in NY

Practice address

18 Jerome Ave
Mineola, NY 11501-3302

Phone

(718) 268-0452

NPI assigned

Feb 8, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502755200000",
    "number": "1245536382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 JEROME AVE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 JEROME AVE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013302",
            "telephone_number": "718-268-0452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "SHADY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-02-08",
        "last_updated": "2017-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "055773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith Lynne Sampson-Chimon, RD
• Gil Samson, M.D.
• Samuel Kenan,MD.,P.C
• Samuel Park MD, PLLC
• Jeffrey T Samuel, DO
• Sonam Sani, M.D.
• Allen Sankovich, RPH
• Natalie Santana, MD
• Aparna Mary Santhosh, NP
• Maria Christine Cordero Santos, NP

• Pediatric Dentistry in Mineola, NY
• Providers in Mineola, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.