Basic Information
| Provider Information | |||||||||
| NPI: | 1336456540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILLIAM | ||||||||
| FirstName: | SINTY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22121 JAMAICA AVE | ||||||||
| Address2: | 2 FLOOR | ||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114282015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184686923 | ||||||||
| FaxNumber: | 7184686925 | ||||||||
| Practice Location | |||||||||
| Address1: | 22121 JAMAICA AVE | ||||||||
| Address2: | 2 FLOOR | ||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114282015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184686923 | ||||||||
| FaxNumber: | 7184686925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2010 | ||||||||
| LastUpdateDate: | 09/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 300760 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.