Provider Demographics
NPI:1548259492
Name:SICKLE-SANTANELLO, BRENDA JEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JEANNE
Last Name:SICKLE-SANTANELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:170 NORTHWOODS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4711
Mailing Address - Country:US
Mailing Address - Phone:614-505-7511
Mailing Address - Fax:614-505-7512
Practice Address - Street 1:170 NORTHWOODS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4711
Practice Address - Country:US
Practice Address - Phone:614-505-7511
Practice Address - Fax:614-505-7512
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350507322086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0696573Medicaid
A82786Medicare UPIN
SI4046701Medicare ID - Type Unspecified