Provider Demographics
NPI:1760034706
Name:EPSTEIN-SANTOYO, JENNAH BUCKAROO
Entity Type:Individual
Prefix:
First Name:JENNAH
Middle Name:BUCKAROO
Last Name:EPSTEIN-SANTOYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNAH
Other - Middle Name:BUCKAROO
Other - Last Name:EPSTEINKRAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:93 CHILTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-6844
Mailing Address - Country:US
Mailing Address - Phone:617-549-6081
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283367163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics