Provider Demographics
NPI:1609139567
Name:SIKAND, POONAM (MSED)
Entity Type:Individual
Prefix:MS
First Name:POONAM
Middle Name:
Last Name:SIKAND
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BAYVIEW AVE W
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6215
Mailing Address - Country:US
Mailing Address - Phone:631-965-2167
Mailing Address - Fax:
Practice Address - Street 1:18 BAYVIEW AVE W
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6215
Practice Address - Country:US
Practice Address - Phone:631-965-2167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency