Healthcare Provider Details

I. General information

NPI: 1093915696
Provider Name (Legal Business Name): MRS. TERI K SIBAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 SW 136TH ST SUITE 203
MIAMI FL
33186-8319
US

IV. Provider business mailing address

13501 SW 136TH ST SUITE 203
MIAMI FL
33186-8319
US

V. Phone/Fax

Practice location:
  • Phone: 305-278-1700
  • Fax: 305-259-7726
Mailing address:
  • Phone: 305-278-1700
  • Fax: 305-259-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: