Provider Demographics
NPI:1326373358
Name:SURIZON, NICOLE M (MS,CCC-SLP TSSLD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:SURIZON
Suffix:
Gender:F
Credentials:MS,CCC-SLP TSSLD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:PERROTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP TSSLD
Mailing Address - Street 1:74 MCARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1925
Mailing Address - Country:US
Mailing Address - Phone:917-359-5625
Mailing Address - Fax:
Practice Address - Street 1:74 MCARTHUR AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1925
Practice Address - Country:US
Practice Address - Phone:917-359-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019569-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist