Provider Demographics
NPI:1740294776
Name:SANTIAGO, RINA SHAILY (PSYD)
Entity type:Individual
Prefix:DR
First Name:RINA
Middle Name:SHAILY
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:151 NW 11TH ST
Mailing Address - Street 2:STE W201
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4361
Mailing Address - Country:US
Mailing Address - Phone:402-483-6990
Mailing Address - Fax:402-483-7045
Practice Address - Street 1:151 NW 11TH STREET
Practice Address - Street 2:SUITE W-201
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030
Practice Address - Country:US
Practice Address - Phone:786-521-5925
Practice Address - Fax:305-716-9114
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470798717-29Medicaid
NE470798717-26Medicaid
NE470798717-27Medicaid