Provider Demographics
NPI:1831975861
Name:SANTORELLA, STEPHANIE JOY
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOY
Last Name:SANTORELLA
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 1:89 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1833
Mailing Address - Country:US
Mailing Address - Phone:351-201-0045
Mailing Address - Fax:
Practice Address - Street 1:89 FOREST ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1833
Practice Address - Country:US
Practice Address - Phone:351-201-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS832765602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer