Provider Demographics
NPI:1154559698
Name:CHEUNG, SAMANTHA ANDREA (MT-BC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANDREA
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40W310 LAFOX RD STE A1B1
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6588
Mailing Address - Country:US
Mailing Address - Phone:630-444-0077
Mailing Address - Fax:630-444-0078
Practice Address - Street 1:40W310 LAFOX RD STE A1B1
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6588
Practice Address - Country:US
Practice Address - Phone:630-444-0077
Practice Address - Fax:630-444-0078
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN08920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist