Provider Demographics
NPI:1225917404
Name:SIBBLIES, DERSHAWN
Entity type:Individual
Prefix:
First Name:DERSHAWN
Middle Name:
Last Name:SIBBLIES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HUNGRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3637
Mailing Address - Country:US
Mailing Address - Phone:516-373-9808
Mailing Address - Fax:
Practice Address - Street 1:656 AVE PONCE DE LEON STE 1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4522
Practice Address - Country:US
Practice Address - Phone:788-998-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program