Provider Demographics
NPI:1104087576
Name:SANTOS-MODESITT, WENDY (PHD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:SANTOS-MODESITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EMBARCADERO W STE 145
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4500
Mailing Address - Country:US
Mailing Address - Phone:415-203-7637
Mailing Address - Fax:
Practice Address - Street 1:11 EMBARCADERO W STE 145
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4500
Practice Address - Country:US
Practice Address - Phone:415-203-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27242103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist