Healthcare Provider Details

I. General information

NPI: 1417471004
Provider Name (Legal Business Name): SHANNON D SANTO WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 W PEORIA AVE # 115A-13
GLENDALE AZ
85302-2023
US

IV. Provider business mailing address

4494 W PEORIA AVE # 115A-13
GLENDALE AZ
85302-2023
US

V. Phone/Fax

Practice location:
  • Phone: 623-295-3605
  • Fax: 623-666-6810
Mailing address:
  • Phone: 623-295-3605
  • Fax: 623-666-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP10427
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number287404
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: