MEDICARE: CHEYENNE SAMRA AHMAD

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	106H00000X	Marriage & Family Therapist	3391	CT

General Provider Information

NPI Number	:	1841155520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEYENNE SAMRA AHMAD

Provider Business Mailing Address
First Line	:	335 CANNON DR
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06614-2089
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ELIOT PL FL 3
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06824-5154
Country	:	US
Telephone Number	:	203-307-3030
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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