MEDICARE: SAMANTHA SANDERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-20-44384	CA

General Provider Information

NPI Number	:	1053927517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA SANDERS

Provider Business Mailing Address
First Line	:	8834 MORRO RD
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-3953
Country	:	US
Telephone Number	:	805-466-7827
Fax Number	:

Provider Business Practice Location Address
First Line	:	8834 MORRO RD
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-3953
Country	:	US
Telephone Number	:	805-466-7827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	09/21/2020

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Directions to “ SAMANTHA SANDERS ” Practice Location

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