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General NPI Number Information
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NPI Number | 1245719749
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Entity Type | Organization
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Legal Business Name | STRATA PSYCHIATRY PLLC
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 200 E TRAVELERS TRL STE 205
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City | BURNSVILLE
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State | MN
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Zip | 55337-4191
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Country | US
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Telephone | 612-254-9782
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Fax | 313-789-1417
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Provider Business Mailing Address
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Address Line | 1937 FREMONT AVE S APT 1
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-2938
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Country | US
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Telephone | 781-856-5437
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Fax |
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Authorized Official
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Title or Position | APRN CNP
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Name | SANDRA HYAMS
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Credential | NP
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Telephone | 781-856-5437
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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 | 4796
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License Number State | MN
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