Healthcare Provider Details

I. General information

NPI: 1316682305
Provider Name (Legal Business Name): SAMANTHA NUZA-OAKLEY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA NUZA

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S BROAD ST
WINSTON SALEM NC
27127-2068
US

IV. Provider business mailing address

1405 S BROAD ST
WINSTON SALEM NC
27127-2068
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone: 855-772-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1545
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: