Healthcare Provider Details

I. General information

NPI: 1902632235
Provider Name (Legal Business Name): SAMANTHA LEE SALDANA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 MONTGOMERY ST
FORT WORTH TX
76107-2553
US

IV. Provider business mailing address

PO BOX 99335
FORT WORTH TX
76199-0335
US

V. Phone/Fax

Practice location:
  • Phone: 817-735-2363
  • Fax: 817-735-2653
Mailing address:
  • Phone: 817-735-2363
  • Fax: 817-735-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number40220
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number40220
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: