Healthcare Provider Details
I. General information
NPI: 1760769046
Provider Name (Legal Business Name): CECILIA KILAYKO GULLAS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3731 73RD ST SUITE 3J
JACKSON HEIGHTS NY
11372-6250
US
IV. Provider business mailing address
3731 73RD ST SUITE 3J
JACKSON HEIGHTS NY
11372-6250
US
V. Phone/Fax
- Phone: 347-617-2099
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA2000X |
| Taxonomy | Administrator Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0200X |
| Taxonomy | Critical Care Medicine Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1400X |
| Taxonomy | College Health Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC2100X |
| Taxonomy | Continence Care Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC3500X |
| Taxonomy | Cardiac Rehabilitation Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WD0400X |
| Taxonomy | Diabetes Educator Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WD1100X |
| Taxonomy | Peritoneal Dialysis Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WE0003X |
| Taxonomy | Emergency Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WE0900X |
| Taxonomy | Enterostomal Therapy Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WF0300X |
| Taxonomy | Flight Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP2201X |
| Taxonomy | Ambulatory Care Registered Nurse |
| License Number | 485480 |
| License Number State | NY |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
