Provider Demographics
NPI:1619470606
Name:MINISI, DINA
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:MINISI
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 1:57 HARROWGATE DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1938
Mailing Address - Country:US
Mailing Address - Phone:610-329-2564
Mailing Address - Fax:
Practice Address - Street 1:57 HARROWGATE DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1938
Practice Address - Country:US
Practice Address - Phone:610-329-2564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PARPL0110311835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst