Individual
MRS. ELLEN ANN SAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
21150 BISCAYNE BLVD, SUITE 408, AVENTURA, FL 33180-1226
(305) 932-3252
(305) 932-2798
Mailing address
11880 SW 40TH ST, SUITE 304, MIAMI, FL 33175-3584
(305) 223-8808
(305) 223-8974
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
PA9103517
FL
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292823000
—
FL
01
—
AL007Y
MEDICARE
FL
01
—
AL007Z
MEDICARE
FL
Enumeration date
10/12/2006
Last updated
06/25/2019
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