Provider Demographics
NPI:1841792595
Name:STONE, SAMANTHA WALKER
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:WALKER
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15276 LEIPZIG CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-8302
Mailing Address - Country:US
Mailing Address - Phone:510-910-5892
Mailing Address - Fax:
Practice Address - Street 1:701 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4098
Practice Address - Country:US
Practice Address - Phone:941-475-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator