Provider Demographics
NPI:1942602784
Name:SICA, CHRISTY DANIELLE I (DA)
Entity type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:DANIELLE
Last Name:SICA
Suffix:I
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-3134
Mailing Address - Country:US
Mailing Address - Phone:516-445-7740
Mailing Address - Fax:
Practice Address - Street 1:970 HOPE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-1224
Practice Address - Country:US
Practice Address - Phone:516-445-7740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00402171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist