Provider Demographics
NPI:1679297329
Name:NARDELLA, NICOLE E
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:NARDELLA
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 1:184 WESTEND AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5240
Mailing Address - Country:US
Mailing Address - Phone:516-660-7078
Mailing Address - Fax:
Practice Address - Street 1:307 EAGLE AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3819
Practice Address - Country:US
Practice Address - Phone:516-986-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist