Provider Demographics
NPI:1275606485
Name:SAMUEL, ROSHNI (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSHNI
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N US HIGHWAY 441 STE 930
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6812
Mailing Address - Country:US
Mailing Address - Phone:352-750-2108
Mailing Address - Fax:352-750-1836
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 930
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6812
Practice Address - Country:US
Practice Address - Phone:352-750-2108
Practice Address - Fax:352-750-1836
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD472440207R00000X, 207RG0300X
NY191208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME147944OtherSTATE LICENSE
FL115092900Medicaid
NY01422802Medicaid
FLPR169OtherMEDICARE
FLPR169OtherMEDICARE