1851489264 NPI number — SHARYN A HICKEY NP

Table of content: SHARYN A HICKEY NP (NPI 1851489264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851489264 NPI number — SHARYN A HICKEY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKEY
Provider First Name:
SHARYN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851489264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-4109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-447-2752
Provider Business Mailing Address Fax Number:
413-496-6836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 LEWIS AVE
Provider Second Line Business Practice Location Address:
FAIRVIEW CARDIOLOGY
Provider Business Practice Location Address City Name:
GT BARRINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01230-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-854-9777
Provider Business Practice Location Address Fax Number:
413-854-9791
Provider Enumeration Date:
10/11/2006

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: 363L00000X , with the licence number:  42908 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0114430 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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