Provider Demographics
NPI:1174340822
Name:MAINA, SAMMY (OWNER)
Entity type:Individual
Prefix:
First Name:SAMMY
Middle Name:
Last Name:MAINA
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 AVONWOOD RD APT 103
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2010
Mailing Address - Country:US
Mailing Address - Phone:959-221-8496
Mailing Address - Fax:
Practice Address - Street 1:47 AVONWOOD RD APT 103
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2010
Practice Address - Country:US
Practice Address - Phone:959-221-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL01591L343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)