Healthcare Provider Details

I. General information

NPI: 1922611987
Provider Name (Legal Business Name): SAMEEN MANNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 NW 186TH ST
MIAMI GARDENS FL
33015-6019
US

IV. Provider business mailing address

6720 E GREEN LAKE WAY N
SEATTLE WA
98103-5439
US

V. Phone/Fax

Practice location:
  • Phone: 305-625-9857
  • Fax:
Mailing address:
  • Phone: 206-525-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL61107451
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA19770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: