Healthcare Provider Details

I. General information

NPI: 1841746120
Provider Name (Legal Business Name): SYLVIE INSHUTI SIBOMANA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRINGBORO PIKE STE C
MORAINE OH
45439-1982
US

IV. Provider business mailing address

2615 WAYLAND AVENUE
DAYTON OH
45420
US

V. Phone/Fax

Practice location:
  • Phone: 937-558-5100
  • Fax:
Mailing address:
  • Phone: 937-559-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number019535
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: