Healthcare Provider Details

I. General information

NPI: 1174127310
Provider Name (Legal Business Name): SAMANTHA VASSOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2020
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 WARDS RD
LYNCHBURG VA
24502-2101
US

IV. Provider business mailing address

2321 WARDS RD
LYNCHBURG VA
24502-2101
US

V. Phone/Fax

Practice location:
  • Phone: 434-582-2273
  • Fax: 434-582-1363
Mailing address:
  • Phone: 434-582-2273
  • Fax: 434-582-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403217-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024184478
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: