Provider Demographics
NPI:1497404552
Name:SIYAT, NAWAL
Entity Type:Individual
Prefix:
First Name:NAWAL
Middle Name:
Last Name:SIYAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 ENERGY PARK DR STE 11
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5249
Mailing Address - Country:US
Mailing Address - Phone:614-525-5550
Mailing Address - Fax:612-230-5880
Practice Address - Street 1:1410 ENERGY PARK DR STE 11
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5249
Practice Address - Country:US
Practice Address - Phone:614-525-5550
Practice Address - Fax:612-230-5880
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician