Provider Demographics
NPI:1174173652
Name:CANADY SAMUEL, JOANN (MED)
Entity type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:CANADY SAMUEL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3443
Mailing Address - Country:US
Mailing Address - Phone:202-262-9561
Mailing Address - Fax:202-462-1824
Practice Address - Street 1:804 3RD ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3443
Practice Address - Country:US
Practice Address - Phone:202-262-9561
Practice Address - Fax:202-462-1824
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist