MEDICARE: MR. SAMUEL JAMES TANZ RBT

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	106S00000X	Behavior Technician	BACB1450305	FL

General Provider Information

NPI Number	:	1598623332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL JAMES TANZ RBT

Provider Business Mailing Address
First Line	:	4839 CHASTAIN DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-1277
Country	:	US
Telephone Number	:	321-507-7785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 DAVIS DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5933
Country	:	US
Telephone Number	:	321-961-7831
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/16/2026

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