Provider Demographics
NPI:1073859724
Name:ROY, SAMRAT (SLP, BCBA)
Entity Type:Individual
Prefix:MR
First Name:SAMRAT
Middle Name:
Last Name:ROY
Suffix:
Gender:M
Credentials:SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 COLEMAN AVE STE E15-1
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4374
Mailing Address - Country:US
Mailing Address - Phone:408-244-1743
Mailing Address - Fax:408-212-9620
Practice Address - Street 1:1400 COLEMAN AVE STE E15-1
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4374
Practice Address - Country:US
Practice Address - Phone:408-244-1743
Practice Address - Fax:408-212-9620
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CASP16034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist