Provider Demographics
NPI:1659192128
Name:SANTALI, AMINA (NP)
Entity type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:SANTALI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 WEDDINGTON RD STE 900
Mailing Address - Street 2:PMB 2078
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-9407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3116 WEDDINGTON RD STE 900
Practice Address - Street 2:PMB 2078
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9407
Practice Address - Country:US
Practice Address - Phone:980-402-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021149363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner