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General NPI Number Information
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NPI Number | 1114811445
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Entity Type | Individual
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Provider Name | SAMANTHA RENEE BEDDOW
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Gender | Female
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 4760 BELPAR ST NW
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City | CANTON
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State | OH
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Zip | 44718-3603
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Country | US
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Telephone | 330-492-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 WOODLEIGH AVE NW
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City | CANTON
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State | OH
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Zip | 44718-2278
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Country | US
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Telephone | 330-800-7640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | APP-000968596
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License Number State | OH
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