Provider Demographics
NPI:1336780709
Name:SANTILLI, CHRISTY (PA)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:SANTILLI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 EARLE ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7623
Mailing Address - Country:US
Mailing Address - Phone:203-414-2010
Mailing Address - Fax:
Practice Address - Street 1:1381 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2502
Practice Address - Country:US
Practice Address - Phone:203-371-5197
Practice Address - Fax:203-371-6118
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4628363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical