Provider Demographics
NPI:1285758797
Name:EDWARDS, SAMANTHA LYNN (MED)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 58TH AVE S
Mailing Address - Street 2:UNIT 1208
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-4600
Mailing Address - Country:US
Mailing Address - Phone:423-676-2443
Mailing Address - Fax:
Practice Address - Street 1:1501 N BELCHER RD
Practice Address - Street 2:SUITE 249
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1339
Practice Address - Country:US
Practice Address - Phone:727-799-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst