Samantha Diedre Adrasse, RBT-21-168594

Primary specialty

Speech-Language AssistantTaxonomy code 2355S0801X

License

SI5594 Issued in FL

Practice address

27844 Manor Oak Dr
Wesley Chapel, FL 33544-5367

Phone

(754) 422-4791

NPI assigned

Mar 16, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1043968266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27844 MANOR OAK DR",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335445367",
            "telephone_number": "754-422-4791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27844 MANOR OAK DR",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335445367",
            "telephone_number": "754-422-4791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADRASSE",
        "first_name": "SAMANTHA",
        "middle_name": "DIEDRE",
        "credential": "RBT-21-168594",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-16",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-21-168594",
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2355S0801X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "FL",
            "license": "SI5594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110674100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.