Samantha Reynolds, M.S.CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202006627 Issued in VA

Practice address

810 Westwood Office Park
Fredericksburg, VA 22401

Phone

(540) 693-6997

NPI assigned

Jul 27, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Samantha Lynn Deshazo Former name

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": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1356697379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 WESTWOOD OFFICE PARK",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "22401",
            "telephone_number": "540-693-6997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 Kingsborough Sq Ste B",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233204988",
            "country_code": "US",
            "telephone_number": "757-547-0434",
            "fax_number": "757-547-0612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "SAMANTHA",
        "name_prefix": "Miss",
        "credential": "M.S.CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-27",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202006627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "DESHAZO",
            "middle_name": "LYNN",
            "credential": "M.S.CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Linda M Reynolds, BS, RDCS, RCVT
• Sarah Saori Reynolds, BCABA
• Whittany Reynolds
• Rheumatology Associates of Central Virginia LLC
• Kylie Rhoades, RBT
• Roohi Riazi, NP

• Speech-Language Pathologist in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; 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.