Provider Demographics
NPI:1639782030
Name:SANTOS, CLAUDIO SAM (APN PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CLAUDIO
Middle Name:SAM
Last Name:SANTOS
Suffix:
Gender:M
Credentials:APN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S REGENT ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3512
Mailing Address - Country:US
Mailing Address - Phone:914-928-2913
Mailing Address - Fax:914-933-3940
Practice Address - Street 1:25 S REGENT ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3512
Practice Address - Country:US
Practice Address - Phone:914-928-2913
Practice Address - Fax:914-933-3940
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01096500363LP0808X
NY403176363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health