Healthcare Provider Details

I. General information

NPI: 1518282557
Provider Name (Legal Business Name): MINDI L SIFUENTES-PAYNE CNIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 SPECTRUM DR STE 1100
ADDISON TX
75001-4648
US

IV. Provider business mailing address

3400 WATERVIEW PKWY STE 305
RICHARDSON TX
75080-1472
US

V. Phone/Fax

Practice location:
  • Phone: 214-295-6703
  • Fax: 214-245-5267
Mailing address:
  • Phone: 214-295-6703
  • Fax: 214-245-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: