=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679387476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KABELYS SIERRA SOLANO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2025
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 622 W 168TH ST FL 14
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-656-1215
-----------------------------------------------------
Fax | 212-305-4343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3060 EDWIN AVE APT 5F
-----------------------------------------------------
City | FORT LEE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07024-4808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-502-7449
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | AG10240078
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------