=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851772255
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA ERIN AUGUSTYN M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2015
-----------------------------------------------------
Last Update Date | 11/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 NW 10TH AVE # BRB-330
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-243-7962
-----------------------------------------------------
Fax | 305-243-7962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1501 NW 10TH AVE # BRB-330
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-243-7962
-----------------------------------------------------
Fax | 305-243-3919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 170300000X
-----------------------------------------------------
Taxonomy Name | Genetic Counselor (M.S.)
-----------------------------------------------------
License Number | GC4
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------