Provider Demographics
NPI:1417471004
Name:SANTO, SHANNON D (CNM)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:D
Last Name:SANTO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1399
Mailing Address - Country:US
Mailing Address - Phone:602-240-2401
Mailing Address - Fax:602-792-0244
Practice Address - Street 1:650 W MARYLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1399
Practice Address - Country:US
Practice Address - Phone:602-240-2401
Practice Address - Fax:602-792-0244
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10427363LW0102X
AZ287404367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health