Provider Demographics
NPI:1558016154
Name:SANTUCCI, DEVON (FNP)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:SANTUCCI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:
Other - Last Name:SHELLENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 GARDEN STATION RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-9366
Mailing Address - Country:US
Mailing Address - Phone:610-955-7275
Mailing Address - Fax:
Practice Address - Street 1:200 HYGEIA DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2049
Practice Address - Country:US
Practice Address - Phone:302-273-1701
Practice Address - Fax:302-273-4497
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022321363LF0000X
DELG-0011578363LF0000X, 363L00000X
DEL1-0047019163W00000X
MDR266210163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner