Provider Demographics
NPI: | 1265846299 |
---|---|
Name: | SICKLER, STEVEN (DNP, FNP-BC, RNFA) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | STEVEN |
Middle Name: | |
Last Name: | SICKLER |
Suffix: | |
Gender: | M |
Credentials: | DNP, FNP-BC, RNFA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 100 METROPOLITAN PARK DR STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | LIVERPOOL |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 13088-7112 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 315-870-9369 |
Mailing Address - Fax: | 315-801-8391 |
Practice Address - Street 1: | 2 ELLINWOOD DR |
Practice Address - Street 2: | |
Practice Address - City: | NEW HARTFORD |
Practice Address - State: | NY |
Practice Address - Zip Code: | 13413-1102 |
Practice Address - Country: | US |
Practice Address - Phone: | 315-724-1012 |
Practice Address - Fax: | 315-235-2039 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-06-18 |
Last Update Date: | 2023-06-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 33 338846 | 363LF0000X, 363LF0000X |
NY | 22 575022 | 163W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 163W00000X | Nursing Service Providers | Registered Nurse |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 03948501 | Medicaid |