Provider Demographics
NPI:1447322987
Name:SANTOS, AMADO SANCHEZ (MD)
Entity type:Individual
Prefix:DR
First Name:AMADO
Middle Name:SANCHEZ
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 PLUM ST
Mailing Address - Street 2:#306
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-1430
Mailing Address - Country:US
Mailing Address - Phone:315-420-5786
Mailing Address - Fax:
Practice Address - Street 1:100 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13261-6100
Practice Address - Country:US
Practice Address - Phone:315-448-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099817171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00562309Medicaid