1760634109 NPI number — MRS. YVETTE M STICCA M.A.

Table of content: MRS. YVETTE M STICCA M.A. (NPI 1760634109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760634109 NPI number — MRS. YVETTE M STICCA M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STICCA
Provider First Name:
YVETTE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROTH
Provider Other First Name:
YVETTE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760634109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5635 E AVON LIMA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14414-9575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-226-6046
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 GIDNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-562-6220
Provider Business Practice Location Address Fax Number:
845-562-6221
Provider Enumeration Date:
10/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  016370-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016370 . This is a "NEW YORK STATE SPEECH AND LANGUAGE PATHOLOGIST LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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