Provider Demographics
NPI:1144882366
Name:SAMSUNDAR, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SAMSUNDAR
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 1:7441 114TH AVE STE 604
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5124
Mailing Address - Country:US
Mailing Address - Phone:727-492-5369
Mailing Address - Fax:
Practice Address - Street 1:506 TIMBER VILLAGE RD
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-8202
Practice Address - Country:US
Practice Address - Phone:352-874-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician