Provider Demographics
NPI:1891971347
Name:SANTIAGO, PAMELA (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:RUEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:95 WEST HUMBOLDT PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-710-5151
Mailing Address - Fax:716-883-0687
Practice Address - Street 1:95 WEST HUMBOLDT PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-710-5151
Practice Address - Fax:716-883-0687
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5152359101Y00000X
NY004564-1101YM0800X
NY422979-1163W00000X
NY402500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00675796Medicaid