Provider Demographics
NPI:1609210541
Name:FIEL, NICOLE LORYN (MSED)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LORYN
Last Name:FIEL
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 1:7400 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5703
Mailing Address - Country:US
Mailing Address - Phone:718-664-3417
Mailing Address - Fax:
Practice Address - Street 1:7400 20TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5703
Practice Address - Country:US
Practice Address - Phone:718-664-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1088227174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist