Provider Demographics
NPI:1316184823
Name:SANTOS, SUZETTE UMBAO (MD)
Entity type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:UMBAO
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E MIDDLE COUNTRY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2923
Mailing Address - Country:US
Mailing Address - Phone:631-979-7222
Mailing Address - Fax:
Practice Address - Street 1:260 E MIDDLE COUNTRY RD STE 107
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2923
Practice Address - Country:US
Practice Address - Phone:631-979-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249387208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03132083Medicaid