Provider Demographics
NPI:1265893465
Name:HOVEYDA, SAMIRA (MSP)
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:HOVEYDA
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 CARDINAL COVE CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6334
Mailing Address - Country:US
Mailing Address - Phone:803-429-0412
Mailing Address - Fax:
Practice Address - Street 1:100 MELROSE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6257
Practice Address - Country:US
Practice Address - Phone:203-869-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist