Provider Demographics
NPI:1346588704
Name:SANTANGELO, DIANE M (ANP-C)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:SANTANGELO
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK MEDICINE
Mailing Address - Street 2:NICOLLS ROAD HOSPITAL LEVEL 13
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-2278
Mailing Address - Country:US
Mailing Address - Phone:631-444-8106
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK MEDICINE
Practice Address - Street 2:NICOLLS ROAD HOSPITAL LEVEL 13
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2278
Practice Address - Country:US
Practice Address - Phone:631-444-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303607363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health