Healthcare Provider Details

I. General information

NPI: 1346075843
Provider Name (Legal Business Name): SAMANTHA SINEATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BOBCAT VILLAGE CENTER RD UNIT G
NORTH PORT FL
34288-8476
US

IV. Provider business mailing address

2500 BOBCAT VILLAGE CENTER RD UNIT G
NORTH PORT FL
34288-8476
US

V. Phone/Fax

Practice location:
  • Phone: 239-778-6574
  • Fax:
Mailing address:
  • Phone: 239-778-6574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2842455
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-370723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: