Provider Demographics
NPI:1164771861
Name:FLORES, NICOLE A
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:A
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,ED
Mailing Address - Street 1:3711 35TH AVE
Mailing Address - Street 2:SUITE 3C-3G
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1524
Mailing Address - Country:US
Mailing Address - Phone:718-706-7500
Mailing Address - Fax:718-706-9595
Practice Address - Street 1:3711 35TH AVE
Practice Address - Street 2:SUITE 3C-3G
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11101-1524
Practice Address - Country:US
Practice Address - Phone:718-706-7500
Practice Address - Fax:718-706-9595
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY864252252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency