Provider Demographics
NPI:1578686572
Name:SANTOS, SONIA R (MSRD,CDN)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:R
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MSRD,CDN
Other - Prefix:MRS
Other - First Name:SONIA
Other - Middle Name:R
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:38 RED SPRING LN
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1755
Mailing Address - Country:US
Mailing Address - Phone:516-801-2225
Mailing Address - Fax:516-801-2225
Practice Address - Street 1:38 RED SPRING LN
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1755
Practice Address - Country:US
Practice Address - Phone:516-801-2225
Practice Address - Fax:516-801-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY438663133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered