Provider Demographics
NPI:1912396177
Name:SANTILLO, ASHLEY NICOLE (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:SANTILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 HAMMOCKS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-7006
Mailing Address - Country:US
Mailing Address - Phone:585-520-2530
Mailing Address - Fax:585-301-4003
Practice Address - Street 1:355 HAMMOCKS DR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-7006
Practice Address - Country:US
Practice Address - Phone:585-520-2530
Practice Address - Fax:585-301-4003
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY664269163WC0200X
NY309179363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine