Healthcare Provider Details

I. General information

NPI: 1083228563
Provider Name (Legal Business Name): SAMANTHA ANGELA HERNANDEZ CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS SAMANTHA ANGELA DEBELLIS

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MERMAID LN
GLENSIDE PA
19038-7600
US

IV. Provider business mailing address

1300 FAIRMOUNT AVE
PHILADELPHIA PA
19123-3588
US

V. Phone/Fax

Practice location:
  • Phone: 267-361-0161
  • Fax:
Mailing address:
  • Phone: 914-406-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL018348
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: