Individual
NICKI SADEGHIPOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5189
(215) 707-2000
Mailing address
412 N FRONT ST UNIT 29, PHILADELPHIA, PA 19123-4238
(267) 614-6269
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA061084
PA
Other
Enumeration date
01/06/2020
Last updated
01/14/2020
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