Provider Demographics
NPI:1356565907
Name:DISANTO, SANDRA COLLEEN (CNP)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:COLLEEN
Last Name:DISANTO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:COLLEEN
Other - Last Name:SAUCIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:DEPARTMENT OF OCCUPATIONAL HEALTH
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-2600
Mailing Address - Fax:
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-5345
Practice Address - Fax:248-465-5357
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206893363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner