Provider Demographics
NPI:1871036186
Name:SANTACROCE, DEIDRA (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:
Last Name:SANTACROCE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:DEIDRA
Other - Middle Name:
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS ED
Mailing Address - Street 1:59 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4239
Mailing Address - Country:US
Mailing Address - Phone:516-361-8591
Mailing Address - Fax:
Practice Address - Street 1:538 BROADHOLLOW RD STE 202
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3668
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist