Healthcare Provider Details

I. General information

NPI: 1235677089
Provider Name (Legal Business Name): SISLY THOMSON RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SISLY M PAREECKAMOLEL RN

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 PASADENA DR
PLAINVIEW NY
11803-3729
US

IV. Provider business mailing address

41 PASADENA DR
PLAINVIEW NY
11803-3729
US

V. Phone/Fax

Practice location:
  • Phone: 516-282-6850
  • Fax:
Mailing address:
  • Phone: 516-282-6850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number572862
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307750
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: