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General NPI Number Information
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NPI Number | 1396458311
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Entity Type | Individual
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Provider Name | JACQUELINE SKYE SIDER RN
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Gender | Female
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 290 LENOX AVE FL 3
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City | NEW YORK
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State | NY
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Zip | 10027-4991
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Country | US
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Telephone | 212-663-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 200 E 18TH ST APT 1J
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City | BROOKLYN
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State | NY
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Zip | 11226-4753
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Country | US
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Telephone | 914-602-1435
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 860111
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License Number State | NY
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