Provider Demographics
NPI:1770876526
Name:SANTALLA, SHARAIN SIRGANY (CD(DONA), EYT)
Entity type:Individual
Prefix:MS
First Name:SHARAIN
Middle Name:SIRGANY
Last Name:SANTALLA
Suffix:
Gender:F
Credentials:CD(DONA), EYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 SW 15TH ST
Mailing Address - Street 2:APT 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1656
Mailing Address - Country:US
Mailing Address - Phone:305-951-0577
Mailing Address - Fax:
Practice Address - Street 1:1257 SW 15TH ST
Practice Address - Street 2:APT. 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1656
Practice Address - Country:US
Practice Address - Phone:305-951-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCD(DONA)374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374J00000X.Medicaid