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General NPI Number Information
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NPI Number | 1164081675
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Entity Type | Individual
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Provider Name | NICOLAS EDWARD SIRIANNI PSYD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2019
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 5106 BUR OAK CIR
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City | RALEIGH
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State | NC
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Zip | 27612-3101
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Country | US
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Telephone | 919-896-0385
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Fax |
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Provider Business Mailing Address
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Address Line | 5106 BUR OAK CIR UPSTAIRS SUITE
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City | RALEIGH
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State | NC
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Zip | 27612-3101
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Country | US
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Telephone | 919-896-0385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6792
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License Number State | NC
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