MEDICARE: SAMANTHA DIANE PRIETO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	24-371945	FL

General Provider Information

NPI Number	:	1871317776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DIANE PRIETO

Provider Business Mailing Address
First Line	:	14621 KIRSTEN CT
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33325-3046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6950 CYPRESS RD STE 103
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-2361
Country	:	US
Telephone Number	:	954-399-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	11/08/2024

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Directions to “ SAMANTHA DIANE PRIETO ” Practice Location

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