Provider Demographics
NPI:1063514347
Name:DISANTO, CLAIRE (RN)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:
Last Name:DISANTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:LAKE HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:12752
Mailing Address - Country:US
Mailing Address - Phone:845-932-9127
Mailing Address - Fax:
Practice Address - Street 1:4504 RT 55
Practice Address - Street 2:DAYTON VILLAGE
Practice Address - City:SWAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12783
Practice Address - Country:US
Practice Address - Phone:845-932-9127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171531163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse