Healthcare Provider Details

I. General information

NPI: 1013823665
Provider Name (Legal Business Name): SAMANTHA AHREUM YI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 SYCOLIN RD STE 220
ASHBURN VA
20147-4328
US

IV. Provider business mailing address

21460 MOUNT STERLING TER UNIT 203
STERLING VA
20164-9390
US

V. Phone/Fax

Practice location:
  • Phone: 571-207-8680
  • Fax:
Mailing address:
  • Phone: 240-328-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012620
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: