Healthcare Provider Details

I. General information

NPI: 1811629942
Provider Name (Legal Business Name): SAMUEL MASTEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD STE 308
TAMPA FL
33606-3438
US

IV. Provider business mailing address

1050 WATER ST UNIT 2122
TAMPA FL
33602-5536
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-0670
  • Fax:
Mailing address:
  • Phone: 701-220-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSL1885
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO3835
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberUO10409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: