Healthcare Provider Details

I. General information

NPI: 1235602558
Provider Name (Legal Business Name): CHARLES SIBILLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STEVE ST
LAFAYETTE LA
70503-6047
US

IV. Provider business mailing address

101 STEVE ST
LAFAYETTE LA
70503-6047
US

V. Phone/Fax

Practice location:
  • Phone: 337-781-6959
  • Fax:
Mailing address:
  • Phone: 337-781-6959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: