Healthcare Provider Details

I. General information

NPI: 1891282570
Provider Name (Legal Business Name): DANIEL SAMET
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N ACADIA RD
THIBODAUX LA
70301-4823
US

IV. Provider business mailing address

1605 MIDDLE GULF DR UNIT 128
SANIBEL FL
33957-7618
US

V. Phone/Fax

Practice location:
  • Phone: 914-787-9004
  • Fax:
Mailing address:
  • Phone: 914-787-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME150473
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number326244
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: