Provider Demographics
NPI:1053951186
Name:SANTOS, SHIRLEY SABADO (MSN,RN,AGPCNP-C,CCRN)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:SABADO
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MSN,RN,AGPCNP-C,CCRN
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:T
Other - Last Name:SABADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3216
Mailing Address - Country:US
Mailing Address - Phone:973-879-4886
Mailing Address - Fax:
Practice Address - Street 1:2010 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3437
Practice Address - Country:US
Practice Address - Phone:973-275-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00947800363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care