Provider Demographics
NPI:1194406744
Name:METELLUS, SAM
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:METELLUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 NORFOLK CT
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-7065
Mailing Address - Country:US
Mailing Address - Phone:267-975-7321
Mailing Address - Fax:
Practice Address - Street 1:1629 NORFOLK CT
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7065
Practice Address - Country:US
Practice Address - Phone:267-975-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator