Provider Demographics
NPI:1851489264
Name:HICKEY, SHARYN A (NP)
Entity Type:Individual
Prefix:
First Name:SHARYN
Middle Name:A
Last Name:HICKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-447-2752
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:29 LEWIS AVE
Practice Address - Street 2:FAIRVIEW CARDIOLOGY
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1713
Practice Address - Country:US
Practice Address - Phone:413-854-9777
Practice Address - Fax:413-854-9791
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0114430Medicaid
MAA31637Medicare ID - Type Unspecified