Provider Demographics
NPI:1396134144
Name:SANTANA, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860157
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-0157
Mailing Address - Country:US
Mailing Address - Phone:904-687-1022
Mailing Address - Fax:904-687-1523
Practice Address - Street 1:412 TALBOT BAY DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-1812
Practice Address - Country:US
Practice Address - Phone:904-687-1022
Practice Address - Fax:904-687-1523
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant