Healthcare Provider Details

I. General information

NPI: 1972292290
Provider Name (Legal Business Name): SYDNEY SANTOS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 FRIES MILL RD STE 101
TURNERSVILLE NJ
08012-2056
US

IV. Provider business mailing address

151 FRIES MILL RD
TURNERSVILLE NJ
08012-2016
US

V. Phone/Fax

Practice location:
  • Phone: 856-374-1881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR20307500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ14910500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: