Healthcare Provider Details

I. General information

NPI: 1619801826
Provider Name (Legal Business Name): MS. PSYCHE MAY CUDIA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 MEDINAH ST
BENSENVILLE IL
60106-1727
US

IV. Provider business mailing address

1303 MEDINAH ST
BENSENVILLE IL
60106-1727
US

V. Phone/Fax

Practice location:
  • Phone: 847-489-7544
  • Fax:
Mailing address:
  • Phone: 847-489-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041548244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: