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General NPI Number Information
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NPI Number | 1649159377
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Entity Type | Individual
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Provider Name | SAMANTHA SHALIA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1317 EDGEWATER DR STE 1604
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City | ORLANDO
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State | FL
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Zip | 32804-6350
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Country | US
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Telephone | 407-620-1924
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Fax |
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Provider Business Mailing Address
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Address Line | 1174 S HIGHLAND AVE
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City | APOPKA
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State | FL
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Zip | 32703-6440
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Country | US
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Telephone | 407-620-1924
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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