Provider Demographics
NPI:1205566494
Name:SINJU, DEREK (APRN)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:SINJU
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 STONELAKE DR APT 334
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-8799
Mailing Address - Country:US
Mailing Address - Phone:617-270-6861
Mailing Address - Fax:
Practice Address - Street 1:2635 STONELAKE DR APT 334
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-8799
Practice Address - Country:US
Practice Address - Phone:617-270-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1077322363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health