Provider Demographics
NPI:1447984893
Name:SHOPOVICK, SAMANTHA G (AU-D)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:G
Last Name:SHOPOVICK
Suffix:
Gender:F
Credentials:AU-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 BEE RIDGE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1515
Mailing Address - Country:US
Mailing Address - Phone:941-379-3277
Mailing Address - Fax:941-379-6277
Practice Address - Street 1:5432 BEE RIDGE RD STE 150
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1515
Practice Address - Country:US
Practice Address - Phone:941-379-3277
Practice Address - Fax:941-379-6277
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2623237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter