Individual ProviderSyisha CooperLicensed Practical NurseNursing Service ProvidersPractice Address30 Walnut Rd, Amityville, NY 11701-1021(347) 792-2410PECOS EnrollmentBased on the most recent information from CMS, provider Syisha Cooper does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1306133723Provider TypeIndividualFull NameCooper, SyishaCredentialLPNGenderFemaleSole ProprietorYesEnumeration Date7/6/2011Last Updated7/21/2011Contact InformationPractice LocationPractice Address30 Walnut Rd, Amityville, NY 11701-1021Phone(347) 792-2410FaxUnlisted FaxMailing LocationMailing Address30 Walnut Rd, Amityville, NY 11701-1021PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense298775-1New York