Provider Demographics
NPI:1497335376
Name:ALONSO, NICOLE PAIGE (MSED)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:PAIGE
Last Name:ALONSO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CROMER ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1708
Mailing Address - Country:US
Mailing Address - Phone:347-446-6016
Mailing Address - Fax:
Practice Address - Street 1:32 CROMER ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1708
Practice Address - Country:US
Practice Address - Phone:347-446-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist