Provider Demographics
NPI:1366781569
Name:HARRIS, SAMEERAH SIDDEQUAH (APN)
Entity type:Individual
Prefix:MISS
First Name:SAMEERAH
Middle Name:SIDDEQUAH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1875
Mailing Address - Country:US
Mailing Address - Phone:609-567-0434
Mailing Address - Fax:609-567-1169
Practice Address - Street 1:3003 ENGLISH CREEK AVE STE C6
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-4818
Practice Address - Country:US
Practice Address - Phone:609-481-3185
Practice Address - Fax:609-569-0104
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00463700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0399442Medicaid
NJ0399442Medicaid