Provider Demographics
NPI:1093050932
Name:MINIOR, SIOBHAN ELIZABETH (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:ELIZABETH
Last Name:MINIOR
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SAINT NICHOLAS TER APT 22
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2836
Mailing Address - Country:US
Mailing Address - Phone:401-450-5892
Mailing Address - Fax:
Practice Address - Street 1:465 W 167TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4351
Practice Address - Country:US
Practice Address - Phone:212-543-3943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00406300363LP0200X
NY382715363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics