Provider Demographics
NPI:1922988369
Name:SAMUELMAN, SANDY LYNN
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:LYNN
Last Name:SAMUELMAN
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 1:1348 N HUNTERSTON PT
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-5788
Mailing Address - Country:US
Mailing Address - Phone:505-433-9690
Mailing Address - Fax:
Practice Address - Street 1:1348 N HUNTERSTON PT
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-5788
Practice Address - Country:US
Practice Address - Phone:505-433-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider