Healthcare Provider Details

I. General information

NPI: 1144360629
Provider Name (Legal Business Name): ROBBAN ARIEL SICA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/O WEST PORT INTEGRATIVE MEDICINE, LLC SUITE 100 1 TURKEY HILL ROAD SOUTH
WESTPORT CT
06880
US

IV. Provider business mailing address

PO BOX 110172
TRUMBULL CT
06611-0172
US

V. Phone/Fax

Practice location:
  • Phone: 203-799-7733
  • Fax: 203-987-4853
Mailing address:
  • Phone: 203-799-7733
  • Fax: 203-987-4853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number026453
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: