Provider Demographics
NPI:1013706779
Name:TIMOTHY, SAMANDRA JAQUELINE VIEIRA (CNC)
Entity type:Individual
Prefix:
First Name:SAMANDRA
Middle Name:JAQUELINE VIEIRA
Last Name:TIMOTHY
Suffix:
Gender:
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 W WILLOW BEND PASEO
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3858
Mailing Address - Country:US
Mailing Address - Phone:801-871-5180
Mailing Address - Fax:
Practice Address - Street 1:885 W WILLOW BEND PASEO
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3858
Practice Address - Country:US
Practice Address - Phone:801-871-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator