Individual
SIBIMOL NIRAVATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1727 N OCEAN AVE, MEDFORD, NY 11763-2649
(631) 654-1919
Mailing address
21 FERNWOOD DR, COMMACK, NY 11725-4715
(631) 456-1126
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
406360
NY
Other
Enumeration date
09/23/2024
Last updated
04/11/2025
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