Provider Demographics
NPI:1861283558
Name:SUEOKA, SAMANTHA MIYUKI
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MIYUKI
Last Name:SUEOKA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 E SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3981
Mailing Address - Country:US
Mailing Address - Phone:801-808-2814
Mailing Address - Fax:
Practice Address - Street 1:987 S GENEVA RD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6085
Practice Address - Country:US
Practice Address - Phone:801-863-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program