Healthcare Provider Details

I. General information

NPI: 1730083411
Provider Name (Legal Business Name): SAMANTHA LEIGH BURKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PHEASANT RUN STE 100
NEWTOWN PA
18940-1877
US

IV. Provider business mailing address

41 FOX CHASE DR
NORTH WALES PA
19454-3646
US

V. Phone/Fax

Practice location:
  • Phone: 215-579-0670
  • Fax:
Mailing address:
  • Phone: 267-568-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008789
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: