Provider Demographics
NPI:1740066737
Name:DE LOS SANTOS, YUDELKA B (PA)
Entity type:Individual
Prefix:
First Name:YUDELKA
Middle Name:B
Last Name:DE LOS SANTOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:YUDELKA
Other - Middle Name:B
Other - Last Name:RODRIGUEZ LIRIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4906 TULIP TREE PL
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2831
Mailing Address - Country:US
Mailing Address - Phone:609-277-4951
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER WAY
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2300
Practice Address - Country:US
Practice Address - Phone:609-653-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00818900363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant