Provider Demographics
NPI:1376963975
Name:SIA, STEPHANE
Entity Type:Individual
Prefix:
First Name:STEPHANE
Middle Name:
Last Name:SIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 DRUMMOND PLZ # 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5741
Mailing Address - Country:US
Mailing Address - Phone:301-873-5066
Mailing Address - Fax:302-543-7176
Practice Address - Street 1:811 N BROAD ST STE 225A
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1173
Practice Address - Country:US
Practice Address - Phone:301-873-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000724363LF0000X
MDAC002929363LP0808X
DEL8-0000215363LP0808X
MDAC001189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health