Provider Demographics
NPI:1952804759
Name:STEPHEN, SIGIMOL
Entity Type:Individual
Prefix:
First Name:SIGIMOL
Middle Name:
Last Name:STEPHEN
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 1:9 PELHAM AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3429
Mailing Address - Country:US
Mailing Address - Phone:845-553-4791
Mailing Address - Fax:
Practice Address - Street 1:9 PELHAM AVE
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3429
Practice Address - Country:US
Practice Address - Phone:845-553-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY581672163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health