Provider Demographics
NPI:1174241152
Name:GROOMS, SIERRA J
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:J
Last Name:GROOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 UPTOWN RD APT 24A
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1609
Mailing Address - Country:US
Mailing Address - Phone:860-709-8859
Mailing Address - Fax:
Practice Address - Street 1:225 S FULTON ST STE D
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3344
Practice Address - Country:US
Practice Address - Phone:607-437-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program