Healthcare Provider Details

I. General information

NPI: 1043574635
Provider Name (Legal Business Name): MRS. KRISTINA CAIAZZO-SIKORSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 10/05/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SOUTHERN LN
WARWICK NY
10990-1919
US

IV. Provider business mailing address

51 SOUTHERN LN
WARWICK NY
10990-1919
US

V. Phone/Fax

Practice location:
  • Phone: 845-544-2659
  • Fax:
Mailing address:
  • Phone: 845-544-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2873346
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: