Healthcare Provider Details

I. General information

NPI: 1275467318
Provider Name (Legal Business Name): CHASTIDY SANTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 610313
BRONX NY
10461-0455
US

IV. Provider business mailing address

PO BOX 610313
BRONX NY
10461-0455
US

V. Phone/Fax

Practice location:
  • Phone: 408-489-1507
  • Fax:
Mailing address:
  • Phone: 408-489-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: