Healthcare Provider Details

I. General information

NPI: 1780599753
Provider Name (Legal Business Name): SAMANTHA SHRECKENGOST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. NELLI SHRECKENGOST

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 SANTA CLARA AVE APT G
ALAMEDA CA
94501-4534
US

IV. Provider business mailing address

2318 SANTA CLARA AVE APT G
ALAMEDA CA
94501-4534
US

V. Phone/Fax

Practice location:
  • Phone: 510-458-4489
  • Fax:
Mailing address:
  • Phone: 510-458-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: