Provider Demographics
NPI:1144852401
Name:SAMAROO, CHANDRAWATIE (RN)
Entity type:Individual
Prefix:MS
First Name:CHANDRAWATIE
Middle Name:
Last Name:SAMAROO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13319 128TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3303
Mailing Address - Country:US
Mailing Address - Phone:917-417-2235
Mailing Address - Fax:
Practice Address - Street 1:13319 128TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3303
Practice Address - Country:US
Practice Address - Phone:917-417-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY506109163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA