Healthcare Provider Details

I. General information

NPI: 1952967663
Provider Name (Legal Business Name): GIULIA DISANTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST RM 1G123
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

3951 34TH ST S APT 4322
ST PETERSBURG FL
33711-5914
US

V. Phone/Fax

Practice location:
  • Phone: 228-376-2273
  • Fax:
Mailing address:
  • Phone: 484-683-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: