MEDICARE: AMANDA SOMTOCHUKWU TABANSI

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	BACB1496538	TX

General Provider Information

NPI Number	:	1912859075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SOMTOCHUKWU TABANSI

Provider Business Mailing Address
First Line	:	1778 N PLANO RD STE 100
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-1962
Country	:	US
Telephone Number	:	956-368-2634
Fax Number	:	234-256-8374

Provider Business Practice Location Address
First Line	:	1778 N PLANO RD STE 100
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-1962
Country	:	US
Telephone Number	:	956-368-2634
Fax Number	:	234-256-8374

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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