Provider Demographics
NPI:1083319636
Name:COHEN, SAMANTHA TAYLOR
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TAYLOR
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 EDGEWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4434
Mailing Address - Country:US
Mailing Address - Phone:248-935-8827
Mailing Address - Fax:
Practice Address - Street 1:3456 EDGEWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4434
Practice Address - Country:US
Practice Address - Phone:248-935-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program