Healthcare Provider Details

I. General information

NPI: 1790225944
Provider Name (Legal Business Name): JAIME LYNN SAMMEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11644 PALMETTO PINE ST
RIVERVIEW FL
33569-6224
US

IV. Provider business mailing address

129 OVERSTREET CT
PALM HARBOR FL
34683-5641
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-17-7820
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-18045
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number19-39452
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: