Healthcare Provider Details

I. General information

NPI: 1508772096
Provider Name (Legal Business Name): NADETH JAMIE SAMNANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 ARLINGTON RD STE G2
BETHESDA MD
20814-5211
US

IV. Provider business mailing address

14807 HAMMERSMITH CIR
SILVER SPRING MD
20906-5728
US

V. Phone/Fax

Practice location:
  • Phone: 301-701-6046
  • Fax:
Mailing address:
  • Phone: 301-971-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM07186
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: