Provider Demographics
NPI:1326808221
Name:BOSTICK BECKFORD, LYNNICSHA S
Entity Type:Individual
Prefix:
First Name:LYNNICSHA
Middle Name:S
Last Name:BOSTICK BECKFORD
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 1:600 FISHERS STATION DR # 105
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9784
Mailing Address - Country:US
Mailing Address - Phone:585-775-6001
Mailing Address - Fax:
Practice Address - Street 1:600 FISHERS STATION DR # 105
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9784
Practice Address - Country:US
Practice Address - Phone:585-775-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver