Provider Demographics
NPI:1306418918
Name:SHROBA, SAMANTHA JOY (RBT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOY
Last Name:SHROBA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 NEW MEISTER LN APT 112
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5960
Mailing Address - Country:US
Mailing Address - Phone:815-993-0665
Mailing Address - Fax:
Practice Address - Street 1:5307 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2249
Practice Address - Country:US
Practice Address - Phone:815-993-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information