Healthcare Provider Details

I. General information

NPI: 1477079895
Provider Name (Legal Business Name): SUNGHYE SIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GLENWOOD RD
MELROSE PARK PA
19027-3522
US

IV. Provider business mailing address

201 GLENWOOD RD
MELROSE PARK PA
19027-3522
US

V. Phone/Fax

Practice location:
  • Phone: 267-808-5764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number018323
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number018323
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number018323
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number018323
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: