Provider Demographics
NPI:1215907241
Name:SANTORO, SHELLY PAIGE (DPT)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:PAIGE
Last Name:SANTORO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:SHELLY
Other - Middle Name:PAIGE
Other - Last Name:OLIVADOTI-SANTORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12056 ALZINA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1100
Mailing Address - Country:US
Mailing Address - Phone:702-406-0128
Mailing Address - Fax:
Practice Address - Street 1:8020 W SAHARA AVE STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7917
Practice Address - Country:US
Practice Address - Phone:702-595-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402011Medicaid