Healthcare Provider Details

I. General information

NPI: 1811660038
Provider Name (Legal Business Name): SAMANTHA MAIDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HARRIS RD
NASHUA NH
03062-2145
US

IV. Provider business mailing address

1 BEAVERBROOK RD
BURLINGTON MA
01803-1203
US

V. Phone/Fax

Practice location:
  • Phone: 603-888-1573
  • Fax:
Mailing address:
  • Phone: 781-724-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberP-0871
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: