MEDICARE: SAMAD CYRUS M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP30716	CA

General Provider Information

NPI Number	:	1013845478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMAD CYRUS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	8446 PERIWINKLE DR
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-2119
Country	:	US
Telephone Number	:	714-308-3004
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 FAIRMONT BLVD
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4446
Country	:	US
Telephone Number	:	714-986-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Language	Start Address	Practice Location

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