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NPI Code Detail

MEDICARE: SOPHIA KICIUK FNP

MEDICARE: SOPHIA KICIUK FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF330452-1NY

General Provider Information

NPI Number : 1114170701
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA KICIUK FNP
Provider Business Mailing Address
First Line : 1111 WESTCHESTER AVE
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10604-3525
Country : US
Telephone Number : 914-253-2770
Fax Number : 914-253-3557
Provider Business Practice Location Address
First Line : 1111 WESTCHESTER AVE
Second Line : PEPSICO EMPLOYEE HEALTH OFFICE
City : WHITE PLAINS
State : NY
Zip : 10604-3525
Country : US
Telephone Number : 914-253-2770
Fax Number : 914-253-3557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2008
Last Update Date : 02/24/2017

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Directions to “ SOPHIA KICIUK FNP” Practice Location

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