Healthcare Provider Details

I. General information

NPI: 1043141013
Provider Name (Legal Business Name): SHALYNN DISANTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 LANCASTER PIKE STE 105
WILMINGTON DE
19805-1511
US

IV. Provider business mailing address

4643 PATRICIAN BLVD APT C
WILMINGTON DE
19808-5514
US

V. Phone/Fax

Practice location:
  • Phone: 302-208-8174
  • Fax:
Mailing address:
  • Phone: 302-513-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: