MEDICARE: WANDA I SANTIAGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1043646714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA I SANTIAGO

Provider Business Mailing Address
First Line	:	14682 BRUNSWOOD WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4204
Country	:	US
Telephone Number	:	347-867-1463
Fax Number	:

Provider Business Practice Location Address
First Line	:	14682 BRUNSWOOD WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4204
Country	:	US
Telephone Number	:	347-867-1463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	11/02/2016

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Directions to “ WANDA I SANTIAGO ” Practice Location

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