Provider Demographics
NPI:1023568672
Name:VELONA, NICOLE MARIE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:VELONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BARBARA PL
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2301
Mailing Address - Country:US
Mailing Address - Phone:732-986-7757
Mailing Address - Fax:
Practice Address - Street 1:11 BARBARA PLACE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ - NEW JERSEY
Practice Address - Zip Code:08817
Practice Address - Country:UM
Practice Address - Phone:732-986-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer