Provider Demographics
NPI:1811735327
Name:SAGODI, SAMANTHA SUSAN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SUSAN
Last Name:SAGODI
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 1:1415 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2207
Mailing Address - Country:US
Mailing Address - Phone:469-781-2630
Mailing Address - Fax:
Practice Address - Street 1:2250 MCGREGOR BLVD STE 3300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3446
Practice Address - Country:US
Practice Address - Phone:888-499-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist