Healthcare Provider Details

I. General information

NPI: 1821554122
Provider Name (Legal Business Name): SAMANTHA JANELLE SIMONI BEHAVIOR TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA JANELLE SHERMAN

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MAGIC HOLLOW BLVD
VIRGINIA BEACH VA
23453
US

IV. Provider business mailing address

3101 MAGIC HOLLOW BLVD
VIRGINIA BEACH VA
23453
US

V. Phone/Fax

Practice location:
  • Phone: 757-837-0761
  • Fax:
Mailing address:
  • Phone: 757-639-2218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: