Provider Demographics
NPI:1790093359
Name:SANTOS, ANA M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 NEWMAN CT
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4929
Mailing Address - Country:US
Mailing Address - Phone:347-829-4767
Mailing Address - Fax:
Practice Address - Street 1:9820 62ND DR APT 15F
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1708
Practice Address - Country:US
Practice Address - Phone:347-829-4767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020184235Z00000X
NY020184-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist