Provider Demographics
NPI:1033844915
Name:FRYE, SAMUEL BENJAMIN
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BENJAMIN
Last Name:FRYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8975 SW 74TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8779
Mailing Address - Country:US
Mailing Address - Phone:540-247-5191
Mailing Address - Fax:
Practice Address - Street 1:3009 SW WILLISTON RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3928
Practice Address - Country:US
Practice Address - Phone:352-294-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA20443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist