Provider Demographics
NPI:1598185951
Name:SAMUELS, SHARON (MS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8072 EXCALIBUR CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8340
Mailing Address - Country:US
Mailing Address - Phone:407-489-7151
Mailing Address - Fax:
Practice Address - Street 1:8072 EXCALIBUR CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8340
Practice Address - Country:US
Practice Address - Phone:407-489-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health