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General NPI Number Information
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NPI Number | 1730530759
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Entity Type | Individual
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Provider Name | SAMANTHA O'BANNON PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2016
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 2 ELLIOTT STREET WEST
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City | CITY OF HAMILTON
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State | CITY OF HAMILTON
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Zip | HM 09
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Country | BM
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Telephone | 441-261-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 2 ELLIOTT STREET WEST
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City | CITY OF HAMILTON
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State | CITY OF HAMILTON
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Zip | HM 09
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Country | BM
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Telephone |
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 32564
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License Number State | CA
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