Provider Demographics
NPI:1275052847
Name:FANOUS-SAMAAN, SYLVIE
Entity Type:Individual
Prefix:MISS
First Name:SYLVIE
Middle Name:
Last Name:FANOUS-SAMAAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SYLVIE
Other - Middle Name:
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14602 OAK VINE DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6371
Practice Address - Country:US
Practice Address - Phone:888-666-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty