Provider Demographics
NPI:1982640629
Name:SANTELLO, JEFFREY S (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:SANTELLO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OXFORD DR STE 211
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1898
Mailing Address - Country:US
Mailing Address - Phone:412-283-0260
Mailing Address - Fax:412-283-0070
Practice Address - Street 1:2000 OXFORD DR STE 211
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1898
Practice Address - Country:US
Practice Address - Phone:412-283-0260
Practice Address - Fax:412-283-0070
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002215L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA002215LOtherMEDICAL LICENSE
PAS63855Medicare UPIN