Healthcare Provider Details

I. General information

NPI: 1912707217
Provider Name (Legal Business Name): SAMIHAH BUKSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 SW 160TH AVE STE 401
SUNRISE FL
33326-1905
US

IV. Provider business mailing address

2598 NW 73RD AVE
SUNRISE FL
33313-2062
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax:
Mailing address:
  • Phone: 754-281-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: