Healthcare Provider Details

I. General information

NPI: 1356470785
Provider Name (Legal Business Name): MARIA SHEENNA SICA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MAIN ST
BAY SHORE NY
11706-8408
US

IV. Provider business mailing address

301 E MAIN ST
BAY SHORE NY
11706-8408
US

V. Phone/Fax

Practice location:
  • Phone: 631-372-7902
  • Fax:
Mailing address:
  • Phone: 631-372-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number205761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: