Nicholas Dephillipo, ST, SA

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

3236 Issued in MN

Practice address

2700 Vikings Cir
Eagan, MN 55121

Phone

(952) 456-7600

NPI assigned

Jul 28, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559692800000",
    "number": "1992113534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR STE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224841",
            "telephone_number": "763-520-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 VIKINGS CIR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "55121",
            "telephone_number": "952-456-7600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1909 Ala Wai Blvd Apt 1006",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968151804",
            "country_code": "US",
            "telephone_number": "609-287-2532",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEPHILLIPO",
        "first_name": "NICHOLAS",
        "credential": "ST, SA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-28",
        "last_updated": "2019-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "3236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Patrick Delaney, M.D.
• Delight Behavioral Center Inc
• Denae Ruble LMFT LLC
• Sandra L Denman, MD
• Dental Specialists of Minnesota, PLLC
• Dermatology Center for Children & Young Adults PA
• Jacob William Des Jardins
• Karin Desrocher, D.C.
• Sandra Kaye Deutsch
• Missy Sue Dever, FNP-BC

• Athletic Trainer in Eagan, MN
• Providers in Eagan, MN by specialty
• Athletic Trainer in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.