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NPI Code Detail

MEDICARE: SAMAR FATHALLA

MEDICARE: SAMAR FATHALLA
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
1103K00000XBehavior Analyst
2106S00000XBehavior Technician

Other Identifiers

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

General Provider Information

NPI Number : 1881269991
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMAR FATHALLA
Provider Business Mailing Address
First Line : 2688 STONEWOOD PARK LOOP
Second Line :
City : LAND O LAKES
State : FL
Zip : 34638-6210
Country : US
Telephone Number : 813-481-9662
Fax Number :
Provider Business Practice Location Address
First Line : 2688 STONEWOOD PARK LOOP
Second Line :
City : LAND O LAKES
State : FL
Zip : 34638-6210
Country : US
Telephone Number : 813-481-9662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2021
Last Update Date : 04/23/2026

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Directions to “ SAMAR FATHALLA ” Practice Location

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