Provider Demographics
NPI:1841683042
Name:SIRIBAN, RITA SHARON AVELINO
Entity type:Individual
Prefix:MS
First Name:RITA SHARON
Middle Name:AVELINO
Last Name:SIRIBAN
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 1:9030 55TH AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4561
Mailing Address - Country:US
Mailing Address - Phone:331-222-2511
Mailing Address - Fax:
Practice Address - Street 1:9030 55TH AVE
Practice Address - Street 2:APT 3
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4561
Practice Address - Country:US
Practice Address - Phone:331-222-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009311-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant