Provider Demographics
NPI:1477307684
Name:SAMAL, NINA MENON
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:MENON
Last Name:SAMAL
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 1:4620 E SILVER SPRINGS BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-3354
Mailing Address - Country:US
Mailing Address - Phone:352-438-0050
Mailing Address - Fax:
Practice Address - Street 1:4620 E SILVER SPRINGS BLVD STE 501
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-3354
Practice Address - Country:US
Practice Address - Phone:352-438-0050
Practice Address - Fax:352-438-0049
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2622231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist