Provider Demographics
NPI:1962193193
Name:HILL, SYREETA JOYCE (LPN)
Entity type:Individual
Prefix:
First Name:SYREETA
Middle Name:JOYCE
Last Name:HILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1235
Mailing Address - Country:US
Mailing Address - Phone:678-956-3314
Mailing Address - Fax:
Practice Address - Street 1:315 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2165
Practice Address - Country:US
Practice Address - Phone:716-816-3847
Practice Address - Fax:716-851-3841
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316082-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse