Provider Demographics
NPI:1396032496
Name:O'LEARY, SAMANTHA S (AUD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:S
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:L
Other - Last Name:SHUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:99 WHITE BRIDGE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1448
Mailing Address - Country:US
Mailing Address - Phone:615-354-8011
Mailing Address - Fax:615-354-8013
Practice Address - Street 1:99 WHITE BRIDGE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1448
Practice Address - Country:US
Practice Address - Phone:615-354-8011
Practice Address - Fax:615-354-8013
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1594231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100181070Medicaid
TN4306078OtherBLUECROSSBLUE SHIELD
TN1525679Medicaid
TN4306078OtherBLUECROSSBLUE SHIELD