Provider Demographics
NPI:1114170701
Name:KICIUK, SOPHIA (FNP)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:KICIUK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:KICIUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1111 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3525
Mailing Address - Country:US
Mailing Address - Phone:914-253-2770
Mailing Address - Fax:914-253-3557
Practice Address - Street 1:1111 WESTCHESTER AVE
Practice Address - Street 2:PEPSICO EMPLOYEE HEALTH OFFICE
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3525
Practice Address - Country:US
Practice Address - Phone:914-253-2770
Practice Address - Fax:914-253-3557
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330452-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily