Healthcare Provider Details

I. General information

NPI: 1245110378
Provider Name (Legal Business Name): SLOANE SANTILLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 10/24/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-770-9095
  • Fax: 724-770-9096
Mailing address:
  • Phone: 724-770-9095
  • Fax: 724-770-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP034183
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN764960
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: