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General NPI Number Information
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NPI Number | 1003179763
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Entity Type | Individual
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Provider Name | MRS. ASHLEY LAURA SICKLER
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Gender | Female
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 4400 VESTAL PKWY
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City | BINGHAMTON
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State | NY
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Zip | 13902-4600
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Country | US
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Telephone | 607-732-9253
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Fax |
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Provider Business Mailing Address
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Address Line | 123 HAYES AVE
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City | ENDICOTT
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State | NY
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Zip | 13760-3102
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Country | US
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Telephone | 607-743-9253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 09611082
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 653021121
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 652874121
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License Number State | NY
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