Healthcare Provider Details

I. General information

NPI: 1770806978
Provider Name (Legal Business Name): SINA N CONICELLI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SINA VANNAME CRNA

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CHESTNUT ST STE 210
PHILADELPHIA PA
19106-2602
US

IV. Provider business mailing address

12 AUSTIN RD
MARLTON NJ
08053-3840
US

V. Phone/Fax

Practice location:
  • Phone: 267-322-7705
  • Fax:
Mailing address:
  • Phone: 609-417-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN613529
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: