Provider Demographics
NPI:1790296002
Name:HICIANO, SHERYL (LPN)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:HICIANO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:
Other - Last Name:BECKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3312
Practice Address - Country:US
Practice Address - Phone:631-525-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248853164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse