MEDICARE: SAMANTHA ELLEN EISEN-SEYDA M.S.,CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA448	FL

General Provider Information

NPI Number	:	1023324258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ELLEN EISEN-SEYDA M.S.,CCC/SLP

Provider Business Mailing Address
First Line	:	3543 BAY ISLAND CIR
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3958
Country	:	US
Telephone Number	:	904-247-1251
Fax Number	:

Provider Business Practice Location Address
First Line	:	3543 BAY ISLAND CIR
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3958
Country	:	US
Telephone Number	:	902-247-1251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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