Provider Demographics
NPI:1952165037
Name:SANTOS, IMANI CHANTAL
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:CHANTAL
Last Name:SANTOS
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 1:2390 2ND AVE APT 13C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2325
Mailing Address - Country:US
Mailing Address - Phone:646-881-9606
Mailing Address - Fax:718-978-0032
Practice Address - Street 1:2390 2ND AVE APT 13C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2325
Practice Address - Country:US
Practice Address - Phone:646-881-9606
Practice Address - Fax:718-978-0032
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345330164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse