MEDICARE: MRS. NICOLE SIBIGA CFO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225000000X	Orthotic Fitter	CFO03140	VA

General Provider Information

NPI Number	:	1720445364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE SIBIGA CFO

Provider Business Mailing Address
First Line	:	4417 IRONWOOD DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5701
Country	:	US
Telephone Number	:	757-581-8827
Fax Number	:	866-452-0279

Provider Business Practice Location Address
First Line	:	4417 IRONWOOD DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5701
Country	:	US
Telephone Number	:	757-581-8827
Fax Number	:	866-452-0279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2016
Last Update Date	:	01/27/2016

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