Provider Demographics
NPI:1043053465
Name:SANTOS, SAMANTHA ALICE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALICE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CRAWFISH LN
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7632
Mailing Address - Country:US
Mailing Address - Phone:803-447-9043
Mailing Address - Fax:
Practice Address - Street 1:501 CRAWFISH LN
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7632
Practice Address - Country:US
Practice Address - Phone:803-447-9043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program