Provider Demographics
NPI:1750541884
Name:SAMUEL, VICKKI-ANN SHEMIKA (MD)
Entity type:Individual
Prefix:
First Name:VICKKI-ANN
Middle Name:SHEMIKA
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18425 NW 2ND AVE STE 404B
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4525
Mailing Address - Country:US
Mailing Address - Phone:305-549-8100
Mailing Address - Fax:
Practice Address - Street 1:18425 NW 2ND AVE STE 404B
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4525
Practice Address - Country:US
Practice Address - Phone:305-549-8100
Practice Address - Fax:786-565-3015
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1092662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry