Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 064059 | CT |
N | 2080P0205X | Pediatric Endocrinologist | MT208972 | PA |
NPI | 1194084541 |
---|---|
Provider Name | Stephanie Lynn Samuels |
First Address | Philadelphia, PA 19104 |
Second Address | New Haven, CT 06504-8901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2012 |
Last Update Date | 29/08/2019 |