MEDICARE: SAMANTHA LYNN FUESY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134433782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LYNN FUESY

Provider Business Mailing Address
First Line	:	5210 20TH AVE S
Second Line	:
City	:	GULFPORT
State	:	FL
Zip	:	33707-4908
Country	:	US
Telephone Number	:	727-417-3269
Fax Number	:

Provider Business Practice Location Address
First Line	:	5902 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-5014
Country	:	US
Telephone Number	:	941-623-2370
Fax Number	:

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

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	09/17/2025

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