Provider Demographics
NPI:1932306354
Name:APONTE-SAMALOT, MYRELIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MYRELIS
Middle Name:
Last Name:APONTE-SAMALOT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193891
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3891
Mailing Address - Country:US
Mailing Address - Phone:787-529-1584
Mailing Address - Fax:148-421-0537
Practice Address - Street 1:403 CALLE DEL PARQUE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3709
Practice Address - Country:US
Practice Address - Phone:787-529-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2716103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical