MEDICARE: SAM THERAPY SERVICES CORP

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

General Provider Information

NPI Number	:	1497609366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAM THERAPY SERVICES CORP

Provider Business Mailing Address
First Line	:	3049 CLEVELAND AVE STE 249
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7046
Country	:	US
Telephone Number	:	754-667-9189
Fax Number	:

Provider Business Practice Location Address
First Line	:	3049 CLEVELAND AVE STE 249
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7046
Country	:	US
Telephone Number	:	754-667-9189
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHEILA AREVALO MIRANDA
Credential	:
Telephone Number	:	754-667-9189

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

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Directions to “SAM THERAPY SERVICES CORP ” Practice Location

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