Provider Demographics
NPI:1447635966
Name:SICA, RICHARD (FNP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SICA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 RIDGE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2203
Mailing Address - Country:US
Mailing Address - Phone:315-337-2500
Mailing Address - Fax:315-337-0720
Practice Address - Street 1:7901 RIDGE MILLS RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2203
Practice Address - Country:US
Practice Address - Phone:315-337-2500
Practice Address - Fax:315-337-0720
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily