MEDICARE: ASHLEY SANTUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1005X	Renal Nutrition Registered Dietitian	ND10560	FL
2	2255A2300X	Athletic Trainer	1220791674	FL
3	133V00000X	Registered Dietitian	ND10560	FL

General Provider Information

NPI Number	:	1710661962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SANTUS

Provider Business Mailing Address
First Line	:	1620 DAVIS DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5933
Country	:	US
Telephone Number	:	412-508-9977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 DAVIS DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5933
Country	:	US
Telephone Number	:	412-508-9977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2023
Last Update Date	:	06/09/2023

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Directions to “ ASHLEY SANTUS ” Practice Location

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