MEDICARE: BRENDA J SICKLE SANTANELLO MD INC

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	174400000X	Specialist
2	174400000X	Specialist	35050732	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962564401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENDA J SICKLE SANTANELLO MD INC

Provider Business Mailing Address
First Line	:	8100 RAVINES EDGE CT
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43235
Country	:	US
Telephone Number	:	614-505-7510
Fax Number	:	614-505-7512

Provider Business Practice Location Address
First Line	:	8100 RAVINES EDGE CT
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43235
Country	:	US
Telephone Number	:	614-505-7510
Fax Number	:	614-505-7512

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	TAMARA M BURK
Credential	:
Telephone Number	:	614-505-7508

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	02/02/2011

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