Provider Demographics
NPI:1710249321
Name:DAVIS, NICOLE S (MSED)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:S
Other - Last Name:DAVIS-WIGFALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:14 NORTH AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3506
Mailing Address - Country:US
Mailing Address - Phone:347-866-7929
Mailing Address - Fax:
Practice Address - Street 1:14 NORTH AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-3506
Practice Address - Country:US
Practice Address - Phone:347-866-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY743285OtherPROFESSIONAL TEACHER CERTIFICATION