Active NPI
Lisa Louise Sickau
- Specialist
- Kenmore, NY
National Provider Identifier
1033430210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 023772-1
- Practice address
- 2900 Delaware Ave
Kenmore, NY 14217-2309 - Phone
- (716) 871-9883
- Fax
- (716) 871-9887
- NPI assigned
- Jun 22, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 023772-1 | NY | Primary |
Addresses
Primary practice location
2900 Delaware Ave
Kenmore, NY 14217-2309
Mailing address
2900 Delaware Ave
Kenmore, NY 14217-2309
Phone (716) 871-9883
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023772-1 | NY | MD | Specialist |
Interoperability endpoints
- lisa.sickau.p3@direct.fallonhealth.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277164800000",
"number": "1033430210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 DELAWARE AVE",
"city": "KENMORE",
"state": "NY",
"postal_code": "142172309",
"telephone_number": "716-871-9883",
"fax_number": "716-871-9887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 DELAWARE AVE",
"city": "KENMORE",
"state": "NY",
"postal_code": "142172309",
"telephone_number": "716-871-9883",
"fax_number": "716-871-9887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SICKAU",
"first_name": "LISA",
"middle_name": "LOUISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-22",
"last_updated": "2010-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "023772-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenmore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.