MEDICARE: SAMUEL FELDMAN PH.D

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	103G00000X	Clinical Neuropsychologist	PY2190	FL

General Provider Information

NPI Number	:	1497132039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL FELDMAN PH.D

Provider Business Mailing Address
First Line	:	2110 NE 206TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-2229
Country	:	US
Telephone Number	:	195-489-4922
Fax Number	:	954-432-8205

Provider Business Practice Location Address
First Line	:	2110 NE 206TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-2229
Country	:	US
Telephone Number	:	195-489-4922
Fax Number	:	954-432-8205

Authorized Official
Title or Position	:	INSURANCE MANAGER
Name	:	MS. KAREN WEISS
Credential	:
Telephone Number	:	954-894-9222

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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