Provider Demographics
NPI:1366045551
Name:DISANTO, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DISANTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 NEW KARNER RD # 12205
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4627
Mailing Address - Country:US
Mailing Address - Phone:518-313-7005
Mailing Address - Fax:
Practice Address - Street 1:251 NEW KARNER RD # 12205
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4627
Practice Address - Country:US
Practice Address - Phone:518-313-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist