Healthcare Provider Details

I. General information

NPI: 1588034862
Provider Name (Legal Business Name): SAMSHINES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 BRIXTON RD
WILLIAMSBURG VA
23185-3868
US

IV. Provider business mailing address

PO BOX 7011
WILLIAMSBURG VA
23188-5233
US

V. Phone/Fax

Practice location:
  • Phone: 757-570-3932
  • Fax:
Mailing address:
  • Phone: 757-570-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberS5754090
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberS5754090
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberS5754090
License Number StateVA

VIII. Authorized Official

Name: MS. SHARRON LORRAINE TAYLOR-HAGGETT
Title or Position: OWNER
Credential: ATP
Phone: 757-570-3932