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General NPI Number Information
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NPI Number | 1215257829
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Entity Type | Individual
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Provider Name | JUDITH ELLENA GROSSO SICKLES CPNP-PC, RN
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Gender | Female
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 301 MANCHESTER RD STE 105
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-2895
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Country | US
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Telephone | 845-452-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 70 KILBAR ROAD
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City | HUDSON
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State | NY
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Zip | 12534
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Country | US
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Telephone | 518-221-9122
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 616136-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 616136-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 616136
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | F383023-01
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | F383023-01
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License Number State | NY
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