Provider Demographics
NPI:1972945772
Name:SAPEIKA, MIRIAM DALIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:DALIA
Last Name:SAPEIKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STULTS RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-2514
Mailing Address - Country:US
Mailing Address - Phone:732-230-3272
Mailing Address - Fax:
Practice Address - Street 1:12 STULTS RD
Practice Address - Street 2:SUITE 123
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-2514
Practice Address - Country:US
Practice Address - Phone:732-230-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00125800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant