Provider Demographics
NPI:1679076632
Name:SAMLAL, AMELIA
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:SAMLAL
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 1:890 PECAN CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6300
Mailing Address - Country:US
Mailing Address - Phone:508-310-3706
Mailing Address - Fax:
Practice Address - Street 1:890 PECAN CT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6300
Practice Address - Country:US
Practice Address - Phone:508-310-3706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2025-05-14
Deactivation Date:2021-07-12
Deactivation Code:
Reactivation Date:2025-05-14
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRN9492606163W00000X
FLIMH27308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163W00000XNursing Service ProvidersRegistered Nurse