License Verification

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SAM VAFADAR

License Number: PA9107217

Data As Of 12/2/2024

Profession
Physician Assistant
License
PA9107217
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
05/07/2013
Address of Record
12902 Magnolia Drive
attn Thoracic Oncology
TAMPA, FL 33612
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
4102 Jim Walter Blvd
TAMPA, FL 33607
Name Relationship Profession License Effective Date
BARATTA, DANIELLE Supervising Prescribing Practitioner Physician Assistant 9104284 07/01/2021
BROHL, ANDREW SCOTT Supervising Prescribing Practitioner Medical Doctor 124615 11/03/2021
CHIAPPORI, ALBERTO ALEJANDRO Supervising Prescribing Practitioner Medical Doctor 86895 07/01/2021
CREELAN, BEN C Supervising Prescribing Practitioner Medical Doctor 105675 07/01/2021
GRAY, JHANELLE ELAINE MD Supervising Prescribing Practitioner Medical Doctor 91405 11/09/2021
HAURA, ERIC BRUCE MD Supervising Prescribing Practitioner Medical Doctor 82324 07/01/2021
PELLINI FERREIRA, BRUNA Supervising Prescribing Practitioner Medical Doctor 145913 07/01/2021
PURI, SONAM Supervising Prescribing Practitioner Medical Doctor 167326 05/16/2024
SALTOS, ANDREAS NICHOLAS Supervising Prescribing Practitioner Medical Doctor 123615 07/01/2021
SHAFIQUE, MICHAEL RAHMAN Supervising Prescribing Practitioner Medical Doctor 119260 07/01/2021
SMIKKER, STEPHANEE CHRISTINA Supervising Prescribing Practitioner Physician Assistant 9107883 11/03/2021
TANVETYANON, TAWEE Supervising Prescribing Practitioner Medical Doctor 93604 07/01/2021
URIBE, MEGAN NICOLE Supervising Prescribing Practitioner Physician Assistant 9109252 07/01/2021

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 12/2/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.