Provider Demographics
NPI:1437929510
Name:SUFICIENCIA, MYLYNN DIONALDO (NP)
Entity type:Individual
Prefix:MRS
First Name:MYLYNN
Middle Name:DIONALDO
Last Name:SUFICIENCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6800 PARK TEN BLVD STE 200S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4293
Mailing Address - Country:US
Mailing Address - Phone:210-261-1060
Mailing Address - Fax:
Practice Address - Street 1:601 N FRIO ST BLDG 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3011
Practice Address - Country:US
Practice Address - Phone:210-261-3750
Practice Address - Fax:210-444-1474
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1116325363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health