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General NPI Number Information
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NPI Number | 1235956095
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Entity Type | Individual
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Provider Name | SIBIMOL NIRAVATH PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 1727 N OCEAN AVE
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City | MEDFORD
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State | NY
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Zip | 11763-2649
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Country | US
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Telephone | 631-654-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 21 FERNWOOD DR
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City | COMMACK
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State | NY
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Zip | 11725-4715
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Country | US
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Telephone | 631-456-1126
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 406360
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License Number State | NY
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