Provider Demographics
NPI:1659048908
Name:SAMAHA, KYRA (CAA)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:SAMAHA
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WELAUNEE BLVD UNIT 501
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5043
Mailing Address - Country:US
Mailing Address - Phone:407-587-6639
Mailing Address - Fax:
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2989
Practice Address - Country:US
Practice Address - Phone:513-585-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11737367H00000X
OH67.000419207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant