Healthcare Provider Details

I. General information

NPI: 1740986348
Provider Name (Legal Business Name): SYLVIA KALLICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 GOODRICH ST
UNIONDALE NY
11553-2400
US

IV. Provider business mailing address

3000 STEVENS ST UNIT 54
OCEANSIDE NY
11572-2039
US

V. Phone/Fax

Practice location:
  • Phone: 516-883-8883
  • Fax: 516-560-8995
Mailing address:
  • Phone: 516-883-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number481662
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number481-662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: