Healthcare Provider Details

I. General information

NPI: 1215857388
Provider Name (Legal Business Name): SHANYNN SANTOS-KHOROLETC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANYNN SANTOS MD

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7935 UNION SQUARE BLVD UNIT 105
FRISCO TX
75034-4187
US

IV. Provider business mailing address

7935 UNION SQUARE BLVD UNIT 105
FRISCO TX
75034-4187
US

V. Phone/Fax

Practice location:
  • Phone: 815-326-2219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: