Healthcare Provider Details

I. General information

NPI: 1699569616
Provider Name (Legal Business Name): HANNAH STICKLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THEALL RD
RYE NY
10580-1404
US

IV. Provider business mailing address

1345 AVENUE OF THE AMERICAS FL 8
NEW YORK NY
10105-0018
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8960
  • Fax: 914-848-8965
Mailing address:
  • Phone: 908-588-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033876
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: