Provider Demographics
NPI:1417833427
Name:SAMUEL, SHEEBA (RT)
Entity type:Individual
Prefix:
First Name:SHEEBA
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-5719
Mailing Address - Country:US
Mailing Address - Phone:954-793-7581
Mailing Address - Fax:
Practice Address - Street 1:815 NW 57TH AVE STE 125
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2068
Practice Address - Country:US
Practice Address - Phone:305-639-8423
Practice Address - Fax:305-397-2243
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12917227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered