Individual
AYESHA FATIN SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
193 E DELAVAN AVE, BUFFALO, NY 14208-1234
(716) 939-2076
Mailing address
193 E DELAVAN AVE, BUFFALO, NY 14208-1234
(716) 939-2076
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
254115
NY
Other
Enumeration date
12/23/2009
Last updated
12/23/2009
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