Healthcare Provider Details

I. General information

NPI: 1851225346
Provider Name (Legal Business Name): AMY MARIE DE SANTIS COA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 N HARRISON AVE STE 20
PIERRE SD
57501-2392
US

IV. Provider business mailing address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

V. Phone/Fax

Practice location:
  • Phone: 605-945-1710
  • Fax: 605-494-0467
Mailing address:
  • Phone: 605-347-2511
  • Fax: 612-725-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number213342
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: