Provider Demographics
NPI:1518051424
Name:STILLER-GUJAR, NICOLE EVELYN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:EVELYN
Last Name:STILLER-GUJAR
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1062
Mailing Address - Country:US
Mailing Address - Phone:646-270-8182
Mailing Address - Fax:
Practice Address - Street 1:64 LAURA LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1062
Practice Address - Country:US
Practice Address - Phone:646-270-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist