Provider Demographics
NPI:1801129093
Name:SANTINI, WANDA IVETTE
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:IVETTE
Last Name:SANTINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15389 S DIXIE HWY APT 47
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1864
Mailing Address - Country:US
Mailing Address - Phone:786-229-8417
Mailing Address - Fax:
Practice Address - Street 1:15389 S DIXIE HWY APT 47
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1864
Practice Address - Country:US
Practice Address - Phone:786-229-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-07
Last Update Date:2009-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist