Provider Demographics
NPI:1477246684
Name:IVO SAMPAIO, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:IVO SAMPAIO
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 1:4932 TANYA LEE CIR APT 6301
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7190
Mailing Address - Country:US
Mailing Address - Phone:813-995-5318
Mailing Address - Fax:
Practice Address - Street 1:4932 TANYA LEE CIR APT 6301
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-7190
Practice Address - Country:US
Practice Address - Phone:813-995-5318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program