Provider Demographics
NPI:1710392808
Name:CUMELLA, NICOLE SANGANI (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SANGANI
Last Name:CUMELLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SANGANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:159 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3067
Mailing Address - Country:US
Mailing Address - Phone:212-228-0950
Mailing Address - Fax:646-843-7606
Practice Address - Street 1:159 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3067
Practice Address - Country:US
Practice Address - Phone:212-228-0950
Practice Address - Fax:646-843-7606
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008186-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist