Provider Demographics
NPI:1265102966
Name:EBLE, SAMANTHA TYLER
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TYLER
Last Name:EBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E 85TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0944
Mailing Address - Country:US
Mailing Address - Phone:943-294-3876
Mailing Address - Fax:
Practice Address - Street 1:1804 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3625
Practice Address - Country:US
Practice Address - Phone:718-828-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist