Basic Information
Provider Information
NPI: 1235875394
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESPINAL
FirstName: SAMANTHA
MiddleName: GISELE
NamePrefix:  
NameSuffix:  
Credential: AU.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1120 NW 14TH ST
Address2:  
City: MIAMI
State: FL
PostalCode: 331362107
CountryCode: US
TelephoneNumber: 3052431110
FaxNumber:  
Practice Location
Address1: 1120 NW 14TH ST STE 573
Address2:  
City: MIAMI
State: FL
PostalCode: 331362107
CountryCode: US
TelephoneNumber: 3052434000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/10/2022
LastUpdateDate: 11/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000XAY2632FLY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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