Healthcare Provider Details

I. General information

NPI: 1487685434
Provider Name (Legal Business Name): EVELYN ALICEA-SAMANIEGO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5431 LIMELIGHT DR
APOLLO BEACH FL
33572-3473
US

IV. Provider business mailing address

P.O BOX 5353
SUN CITY FL
33573
US

V. Phone/Fax

Practice location:
  • Phone: 805-458-2020
  • Fax:
Mailing address:
  • Phone: 805-458-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY11849
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: