Provider Demographics
NPI:1023665098
Name:DISANTI, MICHAEL DOMINICK (AUD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOMINICK
Last Name:DISANTI
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 OAK STUMP DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1849
Mailing Address - Country:US
Mailing Address - Phone:443-867-6376
Mailing Address - Fax:
Practice Address - Street 1:625 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4504
Practice Address - Country:US
Practice Address - Phone:302-724-6624
Practice Address - Fax:320-644-2195
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01494231H00000X
DEO2-0000255231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist