Healthcare Provider Details

I. General information

NPI: 1396955134
Provider Name (Legal Business Name): AMANUEL SAMAD HIMMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AMANUEL AMBAYE DANIACHEW MD

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E ATLANTIC BLVD STE A
POMPANO BEACH FL
33060-6768
US

IV. Provider business mailing address

680 PARK AVE W
MANSFIELD OH
44906-3706
US

V. Phone/Fax

Practice location:
  • Phone: 754-318-3398
  • Fax:
Mailing address:
  • Phone: 855-446-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35.083935
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME153168
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME153168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: