Provider Demographics
NPI:1689374357
Name:NICHOLAS, CARMELA WANDA
Entity Type:Individual
Prefix:
First Name:CARMELA
Middle Name:WANDA
Last Name:NICHOLAS
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 1:2571 47TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1108
Mailing Address - Country:US
Mailing Address - Phone:929-277-1253
Mailing Address - Fax:
Practice Address - Street 1:2571 47TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1108
Practice Address - Country:US
Practice Address - Phone:929-277-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist