MEDICARE: DR. SAMANTHA NORDBY PSYD

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	103TF0200X	Forensic Psychologist	PSY006037	AZ
2	103TC0700X	Clinical Psychologist	PSY006037	AZ

General Provider Information

NPI Number	:	1699629956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA NORDBY PSYD

Provider Business Mailing Address
First Line	:	4901 N JASPER PKWY
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-9518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 N JASPER PKWY
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-9518
Country	:	US
Telephone Number	:	412-370-5044
Fax Number	:

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

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	03/19/2026

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