MEDICARE: SAMUEL PIERRELOUIS

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	251S00000X	Community/Behavioral Health Agency	2632	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487105227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL PIERRELOUIS

Provider Business Mailing Address
First Line	:	PO BOX 617474
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32861-7474
Country	:	US
Telephone Number	:	310-292-2830
Fax Number	:

Provider Business Practice Location Address
First Line	:	3708 CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7608
Country	:	US
Telephone Number	:	310-292-2830
Fax Number	:

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	10/17/2016

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Directions to “ SAMUEL PIERRELOUIS ” Practice Location

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