1861979643 NPI number — MS. PAULA SINISTERRA M.S, NBCC

Table of content: MS. PAULA SINISTERRA M.S, NBCC (NPI 1861979643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861979643 NPI number — MS. PAULA SINISTERRA M.S, NBCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINISTERRA
Provider First Name:
PAULA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S, NBCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861979643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1069 SEABOARD AVE NE APT 14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30307-2628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-995-9456
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 POWERS FERRY RD SE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-953-0080
Provider Business Practice Location Address Fax Number:
770-953-0031
Provider Enumeration Date:
07/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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