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NPI Code Detail

MEDICARE: DR. SANTROY ODANE SAMUELS DO

MEDICARE: DR. SANTROY ODANE SAMUELS DO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramNY
22084P0800XPsychiatry PhysicianOS22116FL

General Provider Information

NPI Number : 1124609342
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANTROY ODANE SAMUELS DO
Provider Business Mailing Address
First Line : 2995 DREW ST FL 2
Second Line :
City : CLEARWATER
State : FL
Zip : 33759-3012
Country : US
Telephone Number : 727-532-0002
Fax Number :
Provider Business Practice Location Address
First Line : 300 PINELLAS ST # MS 70
Second Line :
City : CLEARWATER
State : FL
Zip : 33756-3804
Country : US
Telephone Number : 727-462-3702
Fax Number : 727-298-6702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2021
Last Update Date : 03/13/2026

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