Provider Demographics
NPI:1871040287
Name:CICHY, DIANE (AG-ACNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CICHY
Suffix:
Gender:
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W AVON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3677
Mailing Address - Country:US
Mailing Address - Phone:860-966-0070
Mailing Address - Fax:
Practice Address - Street 1:20 W AVON RD STE 202
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3677
Practice Address - Country:US
Practice Address - Phone:860-866-8982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6575363LA2100X
CT006575363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care