Provider Demographics
NPI:1356581276
Name:FADDA, SAMER A (AP)
Entity type:Individual
Prefix:DR
First Name:SAMER
Middle Name:A
Last Name:FADDA
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10549 N FLORIDA AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6707
Mailing Address - Country:US
Mailing Address - Phone:813-402-2832
Mailing Address - Fax:813-402-2833
Practice Address - Street 1:10549 N FLORIDA AVE
Practice Address - Street 2:SUITE I
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6707
Practice Address - Country:US
Practice Address - Phone:813-402-2832
Practice Address - Fax:813-402-2833
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist