Provider Demographics
NPI:1083153274
Name:SANTOS, NELY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NELY
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1905
Mailing Address - Country:US
Mailing Address - Phone:845-499-5496
Mailing Address - Fax:845-290-1435
Practice Address - Street 1:25 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1905
Practice Address - Country:US
Practice Address - Phone:845-499-5496
Practice Address - Fax:845-290-1435
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337010-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily