Healthcare Provider Details

I. General information

NPI: 1487564282
Provider Name (Legal Business Name): MS. EVELYN SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ELM PL FL 6
BROOKLYN NY
11201-5826
US

IV. Provider business mailing address

25 ELM PL FL 6
BROOKLYN NY
11201-5826
US

V. Phone/Fax

Practice location:
  • Phone: 781-852-5217
  • Fax: 718-852-5211
Mailing address:
  • Phone: 781-852-5217
  • Fax: 718-852-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberNYCPS-P-83653
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: