Healthcare Provider Details

I. General information

NPI: 1093495863
Provider Name (Legal Business Name): SAMANNTHA C MELENDEZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 ELM ST
STIRLING NJ
07980-1105
US

IV. Provider business mailing address

230A PLEASANTVIEW DR
PISCATAWAY NJ
08854-3405
US

V. Phone/Fax

Practice location:
  • Phone: 908-604-4500
  • Fax:
Mailing address:
  • Phone: 917-324-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80901
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: