Healthcare Provider Details

I. General information

NPI: 1295364248
Provider Name (Legal Business Name): SAM FAMENINI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 N DIXIE HWY STE 209
OAKLAND PARK FL
33334-4145
US

IV. Provider business mailing address

5601 N DIXIE HWY STE 209
OAKLAND PARK FL
33334-4145
US

V. Phone/Fax

Practice location:
  • Phone: 954-542-7962
  • Fax:
Mailing address:
  • Phone: 954-542-7962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME183874
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME183874
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME183874
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME183874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: