Provider Demographics
NPI:1306043336
Name:SICA, SUSAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:SICA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5364 UPPER MOUNT MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14481-9776
Mailing Address - Country:US
Mailing Address - Phone:585-382-9247
Mailing Address - Fax:
Practice Address - Street 1:5364 UPPER MOUNT MORRIS RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NY
Practice Address - Zip Code:14481-9776
Practice Address - Country:US
Practice Address - Phone:585-382-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276732-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02632731Medicaid