Provider Demographics
NPI:1215257829
Name:SICKLES, JUDITH ELLENA GROSSO (CPNP-PC, RN)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ELLENA GROSSO
Last Name:SICKLES
Suffix:
Gender:F
Credentials:CPNP-PC, RN
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:ELLENA
Other - Last Name:GROSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 KILBAR ROAD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534
Mailing Address - Country:US
Mailing Address - Phone:518-221-9122
Mailing Address - Fax:
Practice Address - Street 1:301 MANCHESTER RD STE 105
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2895
Practice Address - Country:US
Practice Address - Phone:845-452-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY616136-1163WH0200X, 163WP0200X
NY616136163W00000X
NYF383023-01363LP0222X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care