Healthcare Provider Details

I. General information

NPI: 1447984893
Provider Name (Legal Business Name): SAMANTHA G SHOPOVICK AU-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4937 CLARK RD STE 101
SARASOTA FL
34233-3241
US

IV. Provider business mailing address

5432 BEE RIDGE RD STE 150
SARASOTA FL
34233-1515
US

V. Phone/Fax

Practice location:
  • Phone: 941-379-3277
  • Fax:
Mailing address:
  • Phone: 941-379-3277
  • Fax: 941-379-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY2623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: