Healthcare Provider Details

I. General information

NPI: 1225281496
Provider Name (Legal Business Name): SYREETA OLIVIA DHOLICHAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 ABERDEEN ST
ROCHESTER NY
14619-1338
US

IV. Provider business mailing address

393 ABERDEEN ST
ROCHESTER NY
14619-1338
US

V. Phone/Fax

Practice location:
  • Phone: 917-769-7887
  • Fax: 585-340-6215
Mailing address:
  • Phone: 917-769-7887
  • Fax: 585-340-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number559826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: