Healthcare Provider Details

I. General information

NPI: 1568375830
Provider Name (Legal Business Name): VLADA KSIDO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E 12TH ST FL 2
BROOKLYN NY
11229-1013
US

IV. Provider business mailing address

7 BEAUMONT ST
BROOKLYN NY
11235-4103
US

V. Phone/Fax

Practice location:
  • Phone: 718-942-4500
  • Fax:
Mailing address:
  • Phone: 917-572-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number516504-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: