Provider Demographics
NPI:1114412186
Name:GALLETTI, NICHOLLE-CHRISTINE
Entity Type:Individual
Prefix:
First Name:NICHOLLE-CHRISTINE
Middle Name:
Last Name:GALLETTI
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 1:12740 SW 117TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4613
Mailing Address - Country:US
Mailing Address - Phone:786-439-9012
Mailing Address - Fax:
Practice Address - Street 1:12740 SW 117TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4613
Practice Address - Country:US
Practice Address - Phone:786-439-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty