Provider Demographics
NPI:1164707493
Name:SCHILLER, NICOLE MARIE MASULA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE MASULA
Last Name:SCHILLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5750
Mailing Address - Country:US
Mailing Address - Phone:607-247-2129
Mailing Address - Fax:
Practice Address - Street 1:520 HUDSON ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5750
Practice Address - Country:US
Practice Address - Phone:607-247-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020570-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02570-1OtherNYS DEPT. OF ED. OFFICE OF THE PROFESSIONS