Provider Demographics
NPI:1770806978
Name:CONICELLI, SINA N (CRNA)
Entity type:Individual
Prefix:
First Name:SINA
Middle Name:N
Last Name:CONICELLI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SINA
Other - Middle Name:
Other - Last Name:VANNAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:12 AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3840
Mailing Address - Country:US
Mailing Address - Phone:609-417-4342
Mailing Address - Fax:
Practice Address - Street 1:325 CHESTNUT ST STE 210
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2602
Practice Address - Country:US
Practice Address - Phone:267-322-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN613529367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered