Healthcare Provider Details

I. General information

NPI: 1932363777
Provider Name (Legal Business Name): SHEILA EDNA SANTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N HIGH ST
COLUMBUS OH
43201-2409
US

IV. Provider business mailing address

3033 KETTERING BLVD STE 100
MORAINE OH
45439-1948
US

V. Phone/Fax

Practice location:
  • Phone: 614-340-6777
  • Fax:
Mailing address:
  • Phone: 937-293-2133
  • Fax: 855-252-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL17990
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD603229220
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.122797
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD154264
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: