Healthcare Provider Details

I. General information

NPI: 1114811445
Provider Name (Legal Business Name): SAMANTHA RENEE BEDDOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 BELPAR ST NW
CANTON OH
44718-3603
US

IV. Provider business mailing address

3901 WOODLEIGH AVE NW
CANTON OH
44718-2278
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-9200
  • Fax:
Mailing address:
  • Phone: 330-800-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberAPP-000968596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: