Provider Demographics
NPI:1003179763
Name:SICKLER, ASHLEY LAURA
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LAURA
Last Name:SICKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-3102
Mailing Address - Country:US
Mailing Address - Phone:607-743-9253
Mailing Address - Fax:
Practice Address - Street 1:4400 VESTAL PKWY
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902-4600
Practice Address - Country:US
Practice Address - Phone:607-732-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09611082174400000X
NY653021121174400000X
NY652874121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist