Provider Demographics
NPI:1003672361
Name:SAINTILMOND, LUCIANY (PA)
Entity Type:Individual
Prefix:
First Name:LUCIANY
Middle Name:
Last Name:SAINTILMOND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 CHASE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-0400
Mailing Address - Country:US
Mailing Address - Phone:178-136-3295
Mailing Address - Fax:
Practice Address - Street 1:9707 CHASE VIEW DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-0400
Practice Address - Country:US
Practice Address - Phone:781-363-2854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10198363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant