Provider Demographics
NPI:1467610006
Name:CONSTANTINE, SHADIA SANTOS (MD)
Entity Type:Individual
Prefix:
First Name:SHADIA
Middle Name:SANTOS
Last Name:CONSTANTINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHADIA
Other - Middle Name:SAMIRA
Other - Last Name:SANTOS DONOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6911
Mailing Address - Country:US
Mailing Address - Phone:671-645-5500
Mailing Address - Fax:
Practice Address - Street 1:133 ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6911
Practice Address - Country:US
Practice Address - Phone:671-645-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435651207R00000X
GUM-2067207R00000X, 208M00000X
GUMTL-2017-078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine