Provider Demographics
NPI:1124278908
Name:GLYN, SAMARA GABRIEL
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:GABRIEL
Last Name:GLYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 SW 92ND ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7397
Mailing Address - Country:US
Mailing Address - Phone:305-342-9886
Mailing Address - Fax:
Practice Address - Street 1:8600 SW 92ND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7397
Practice Address - Country:US
Practice Address - Phone:305-342-9886
Practice Address - Fax:305-596-9996
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist