Healthcare Provider Details

I. General information

NPI: 1003312810
Provider Name (Legal Business Name): SAMANTHA MEGAN WYCKOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA MEGAN LABIB MD

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W LANCASTER AVE
DEVON PA
19333-1560
US

IV. Provider business mailing address

1065 NE 125TH ST STE 300
NORTH MIAMI FL
33161-5833
US

V. Phone/Fax

Practice location:
  • Phone: 484-654-9900
  • Fax:
Mailing address:
  • Phone: 888-852-6672
  • 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 Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number306481-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD480318
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD480318
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: