MEDICARE: SAMANTHA AMAYA PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1144095175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA AMAYA PA

Provider Business Mailing Address
First Line	:	2774 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2927
Country	:	US
Telephone Number	:	954-791-5184
Fax Number	:

Provider Business Practice Location Address
First Line	:	2774 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2927
Country	:	US
Telephone Number	:	954-791-5184
Fax Number	:

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

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	07/25/2024

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