Provider Demographics
NPI:1952601643
Name:SAMA, SHOBA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:SHOBA
Middle Name:REDDY
Last Name:SAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1501 1ST STREET SOUTH
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880
Mailing Address - Country:US
Mailing Address - Phone:866-229-2540
Mailing Address - Fax:863-229-1230
Practice Address - Street 1:1501 1ST ST S
Practice Address - Street 2:STE B
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4307
Practice Address - Country:US
Practice Address - Phone:863-229-2540
Practice Address - Fax:863-229-1230
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME108394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine