Provider Demographics
NPI:1588551139
Name:FEDORYKA, NINA
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:FEDORYKA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MANTUA BLVD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1009
Mailing Address - Country:US
Mailing Address - Phone:856-272-2622
Mailing Address - Fax:
Practice Address - Street 1:1919 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1619
Practice Address - Country:US
Practice Address - Phone:800-845-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07282700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health