Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | ME149583 | FL |
NPI | 1578957486 |
---|---|
Provider Name | Samantha Britni Allen |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021-5403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2015 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111216100 | (05) | FL |