Mary Candida Tsidemidis I

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

336883-01 Issued in NY

Practice address

295 7TH Ave
Saint James, NY 11780-2436

Phone

(631) 487-1627

NPI assigned

Jan 8, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1619747813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 KNOTT DR",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115424143",
            "telephone_number": "516-676-5965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 7TH AVE",
            "city": "SAINT JAMES",
            "state": "NY",
            "postal_code": "117802436",
            "telephone_number": "631-487-1627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSIDEMIDIS",
        "first_name": "MARY",
        "middle_name": "CANDIDA",
        "name_suffix": "I",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "NY",
            "license": "336883-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Registered Nurse in Saint James, NY
• Providers in Saint James, NY by specialty
• General Practice Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.