Provider Demographics
NPI:1093241986
Name:KASSAMALI RICKICKI, SORAYYA (LM, CM, IBCLC)
Entity Type:Individual
Prefix:
First Name:SORAYYA
Middle Name:
Last Name:KASSAMALI RICKICKI
Suffix:
Gender:F
Credentials:LM, CM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 E 10TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4256
Mailing Address - Country:US
Mailing Address - Phone:917-783-9561
Mailing Address - Fax:888-810-7628
Practice Address - Street 1:410 E 13TH ST
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3704
Practice Address - Country:US
Practice Address - Phone:917-783-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-109824174N00000X
NYF001941367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN