Provider Demographics
NPI:1215600739
Name:SLATER, SAMANTHA CRISTINA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CRISTINA
Last Name:SLATER
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 1:1504 VERACRUZ LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1737
Mailing Address - Country:US
Mailing Address - Phone:954-531-9136
Mailing Address - Fax:
Practice Address - Street 1:15165 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7801
Practice Address - Country:US
Practice Address - Phone:305-828-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty