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NPI Code Detail

MEDICARE: SAMANTHA RYAN

MEDICARE: SAMANTHA RYAN
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
1103K00000XBehavior Analyst1-19-39884FL

Other Identifiers

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

General Provider Information

NPI Number : 1699134858
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA RYAN
Provider Business Mailing Address
First Line : 9664 LAKE CHASE ISLAND WAY
Second Line :
City : TAMPA
State : FL
Zip : 33626-1936
Country : US
Telephone Number : 352-263-6808
Fax Number :
Provider Business Practice Location Address
First Line : 5447 E BEAUMONT CENTER BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33634-5210
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2016
Last Update Date : 03/08/2022

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