Provider Demographics
NPI:1962120741
Name:ENGLAISH, SAMANTHA BEVERLY (AUD)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:BEVERLY
Last Name:ENGLAISH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 GLADIOLUS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4492
Mailing Address - Country:US
Mailing Address - Phone:239-267-7888
Mailing Address - Fax:239-267-0409
Practice Address - Street 1:8900 GLADIOLUS DR STE 201
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4492
Practice Address - Country:US
Practice Address - Phone:239-267-7888
Practice Address - Fax:239-267-0409
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLAY2644231H00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0000OtherN/A
FLAY2644OtherLICENSE