Healthcare Provider Details

I. General information

NPI: 1033750385
Provider Name (Legal Business Name): SAMANTHA RANNAZZISI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 QUINCE PL
CHESAPEAKE VA
23320-0769
US

IV. Provider business mailing address

4950 CASABLANCA RD
VIRGINIA BEACH VA
23455-2225
US

V. Phone/Fax

Practice location:
  • Phone: 828-208-2487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-53728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: