Basic Information
| Provider Information | |||||||||
| NPI: | 1669712527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOUDHURY | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22736 SLEEPY BROOK LN | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334285728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612390972 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 39200 HOOKER HWY | ||||||||
| Address2: | LAKESIDE MEDICAL CENTER | ||||||||
| City: | BELLE GLADE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619966571 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS14376 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.