Healthcare Provider Details

I. General information

NPI: 1396685681
Provider Name (Legal Business Name): AUDREY LYNN SAMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43045 HUGH DR UNIT B3
HOLLYWOOD MD
20636-2531
US

IV. Provider business mailing address

43045 HUGH DR UNIT B3
HOLLYWOOD MD
20636-2531
US

V. Phone/Fax

Practice location:
  • Phone: 240-491-7607
  • Fax:
Mailing address:
  • Phone: 240-491-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: