Provider Demographics
NPI:1598791360
Name:MULLIS, SAMANTHA LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LYNNE
Last Name:MULLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:LYNNE
Other - Last Name:MULLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9 NW 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444
Mailing Address - Country:US
Mailing Address - Phone:203-554-0893
Mailing Address - Fax:
Practice Address - Street 1:BETHESDA EAST HOSPITAL
Practice Address - Street 2:2815 SEACREST BLVD
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-737-7733
Practice Address - Fax:203-325-8677
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036211207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00781700Medicaid
NY00781700Medicaid
NY01171QMedicare ID - Type Unspecified