Provider Demographics
NPI:1467507582
Name:SANTORIELLO, KATHY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:ANN
Last Name:SANTORIELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 SE HARBOR CIRCLE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996
Mailing Address - Country:US
Mailing Address - Phone:772-419-0505
Mailing Address - Fax:772-781-7327
Practice Address - Street 1:900 SE OCEAN BLVD
Practice Address - Street 2:SUITE 330-D
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2471
Practice Address - Country:US
Practice Address - Phone:772-419-0505
Practice Address - Fax:772-781-7327
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME 68461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43005OtherBCBS
F 00313Medicare UPIN
FLU3492WMedicare PIN
FLF0013Medicare UPIN