Healthcare Provider Details

I. General information

NPI: 1659295798
Provider Name (Legal Business Name): SAMA AZAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 DANIELS RD
WINTER GARDEN FL
34787-3836
US

IV. Provider business mailing address

5554 METROWEST BLVD APT 306
ORLANDO FL
32811-2459
US

V. Phone/Fax

Practice location:
  • Phone: 407-614-0616
  • Fax:
Mailing address:
  • Phone: 407-443-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: