Provider Demographics
NPI:1902191760
Name:WHEATLEY, SIDIA MARITZA (RN)
Entity Type:Individual
Prefix:
First Name:SIDIA
Middle Name:MARITZA
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5129
Mailing Address - Country:US
Mailing Address - Phone:917-513-2233
Mailing Address - Fax:
Practice Address - Street 1:1431 E 85TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5129
Practice Address - Country:US
Practice Address - Phone:917-513-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY386897163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse