Healthcare Provider Details

I. General information

NPI: 1164386561
Provider Name (Legal Business Name): SAMARIA SADE VINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N 5TH ST
SMITHFIELD NC
27577-3930
US

IV. Provider business mailing address

212 N 5TH ST
SMITHFIELD NC
27577-3930
US

V. Phone/Fax

Practice location:
  • Phone: 919-464-8251
  • Fax:
Mailing address:
  • Phone: 919-464-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23052
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: