MEDICARE: SAMANTHA GRAHAM

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	374J00000X	Doula		FL

General Provider Information

NPI Number	:	1417705542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA GRAHAM

Provider Business Mailing Address
First Line	:	7500 W COMMERCIAL BLVD # 1046
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2132
Country	:	US
Telephone Number	:	954-864-7752
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 W COMMERCIAL BLVD # 1046
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2132
Country	:	US
Telephone Number	:	954-864-7752
Fax Number	:

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

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	05/13/2024

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Directions to “ SAMANTHA GRAHAM ” Practice Location

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