Provider Demographics
NPI:1982691481
Name:SYTA, CHERYL (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:SYTA
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 1:6 MEDICAL PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-5053
Mailing Address - Country:US
Mailing Address - Phone:518-289-2717
Mailing Address - Fax:518-886-5247
Practice Address - Street 1:6 MEDICAL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-5053
Practice Address - Country:US
Practice Address - Phone:518-289-2717
Practice Address - Fax:518-886-5247
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303528363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P77761Medicare UPIN