Provider Demographics
NPI:1679503767
Name:SANTASIERO, DEBRA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANN
Last Name:SANTASIERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1205
Mailing Address - Country:US
Mailing Address - Phone:407-324-5035
Mailing Address - Fax:407-321-5266
Practice Address - Street 1:309 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1205
Practice Address - Country:US
Practice Address - Phone:407-324-5035
Practice Address - Fax:407-321-5266
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6404208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374550300Medicaid
FL68705Medicare UPIN