=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669445912
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MYRTA N SIFONTE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2006
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
-----------------------------------------------------
City | APO AE
-----------------------------------------------------
State | GERMANY
-----------------------------------------------------
Zip | 09180
-----------------------------------------------------
Country | DE
-----------------------------------------------------
Telephone | 314-590-6311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | UNIT 33100 BOX LANDSTUHL
-----------------------------------------------------
City | APO
-----------------------------------------------------
State | AE
-----------------------------------------------------
Zip | 09180-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-590-6311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 13426
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 13426
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------