MEDICARE: SAMANTHA WILBURN CSFA

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1184577595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA WILBURN CSFA

Provider Business Mailing Address
First Line	:	3997 SAN MARINO ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-1313
Country	:	US
Telephone Number	:	740-222-4798
Fax Number	:

Provider Business Practice Location Address
First Line	:	3997 SAN MARINO ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-1313
Country	:	US
Telephone Number	:	740-222-4798
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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