Healthcare Provider Details

I. General information

NPI: 1992115398
Provider Name (Legal Business Name): BICKY VETTICHIRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF MEDICINE HSC LEVEL 16 SUNY STONY BROOK
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

STONY BROOK TEACHING HOSPITAL DEPTARTMENT OF MEDICINE PO BOX 1508
STONY BROOK NY
11794-8430
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-7411
  • Fax: 631-444-2493
Mailing address:
  • Phone: 631-444-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number304063
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: