Provider Demographics
NPI:1215304449
Name:SANTORA, KEESHA SHARAY
Entity type:Individual
Prefix:
First Name:KEESHA SHARAY
Middle Name:
Last Name:SANTORA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 COUNTY ROAD 3662
Mailing Address - Street 2:
Mailing Address - City:QUEEN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75572-5302
Mailing Address - Country:US
Mailing Address - Phone:469-912-1006
Mailing Address - Fax:
Practice Address - Street 1:2010 MOORES LN STE 108
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4645
Practice Address - Country:US
Practice Address - Phone:469-912-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
TX13033361744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1303336OtherTEXAS DEPARTMENT OF LICENSING & REGISTRATION