Provider Demographics
NPI:1679337166
Name:HILL, SYREETA CYNTHIA
Entity Type:Individual
Prefix:
First Name:SYREETA
Middle Name:CYNTHIA
Last Name:HILL
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:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830
Mailing Address - Country:US
Mailing Address - Phone:160-722-6011
Mailing Address - Fax:
Practice Address - Street 1:402 EAST FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760
Practice Address - Country:US
Practice Address - Phone:607-226-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist