Provider Demographics
NPI:1710307343
Name:SIEBOLD, JUDI L (NP)
Entity type:Individual
Prefix:
First Name:JUDI
Middle Name:L
Last Name:SIEBOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-6029
Mailing Address - Country:US
Mailing Address - Phone:845-240-2995
Mailing Address - Fax:
Practice Address - Street 1:370 VIOLET AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1034
Practice Address - Country:US
Practice Address - Phone:845-471-1807
Practice Address - Fax:845-471-1815
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382232163W00000X
NYF403429-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse