Provider Demographics
NPI:1619131430
Name:NEVADUNSKY, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NEVADUNSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 EASTCHESTER RD
Mailing Address - Street 2:SUITE 602
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2374
Mailing Address - Country:US
Mailing Address - Phone:718-405-8020
Mailing Address - Fax:
Practice Address - Street 1:3332 ROCHAMBEAU CENTENNIAL WOMEN'S CENTER
Practice Address - Street 2:SUITE C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6110
Practice Address - Country:US
Practice Address - Phone:718-920-4794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist