Provider Demographics
NPI:1790093334
Name:PEREIRA, NICOLE TEMINO (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:TEMINO
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:TEMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5881 SW 13TH TER
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5707
Mailing Address - Country:US
Mailing Address - Phone:305-778-5446
Mailing Address - Fax:
Practice Address - Street 1:3601 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4377
Practice Address - Country:US
Practice Address - Phone:786-624-5227
Practice Address - Fax:305-418-7705
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 16802355S0801X
FLSZ5716235Z00000X
FLSA12020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant