NPI 1114798758

Samuel Deadwyler

Practitioner Driver Brooklyn, NY

Practice location

Address: 1350 Bedford Ave APT 3m, Brooklyn, NY 11216-5804
Phone: (516) 451-4155

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 511051614 (NY)

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Registry record

NPI: 1114798758
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 Jan 2024
Record last updated: 11 Jan 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.