Provider Demographics
NPI:1588190110
Name:SAMSON, DAYANA MAGALIE
Entity Type:Individual
Prefix:
First Name:DAYANA
Middle Name:MAGALIE
Last Name:SAMSON
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 1:11601 SW 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-4805
Mailing Address - Country:US
Mailing Address - Phone:786-514-6216
Mailing Address - Fax:
Practice Address - Street 1:11601 SW 64TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-4805
Practice Address - Country:US
Practice Address - Phone:786-514-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085007407363A00000X
FLPA9110583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant