Provider Demographics
NPI:1497055206
Name:GILKES, NINA AQUILLA (SPL)
Entity Type:Individual
Prefix:MISS
First Name:NINA
Middle Name:AQUILLA
Last Name:GILKES
Suffix:
Gender:F
Credentials:SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 170TH ST APT 1P
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5302
Mailing Address - Country:US
Mailing Address - Phone:718-847-7689
Mailing Address - Fax:
Practice Address - Street 1:8900 170TH ST APT 1P
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5302
Practice Address - Country:US
Practice Address - Phone:718-847-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1927901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist