Healthcare Provider Details

I. General information

NPI: 1275399644
Provider Name (Legal Business Name): SAMANTHA ANGELA MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 NW FEDERAL HWY STE 173
STUART FL
34994-1019
US

IV. Provider business mailing address

17360 SW 302ND ST
HOMESTEAD FL
33030-3310
US

V. Phone/Fax

Practice location:
  • Phone: 954-579-7973
  • Fax:
Mailing address:
  • Phone: 305-484-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB1065113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: