Individual
DR. SHEILLA KICONCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3015 3RD AVE SE STE 104, ABERDEEN, SD 57401-5539
(605) 725-6700
(605) 725-6708
Mailing address
1749 GRAND CONCOURSE APT 9G, BRONX, NY 10453
(914) 258-1361
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12075
SD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/29/2017
Last updated
09/15/2020
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