Provider Demographics
NPI:1811542053
Name:BIONDOLETTI, NICOLE (PSYD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BIONDOLETTI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S HOOVER BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3574
Mailing Address - Country:US
Mailing Address - Phone:813-563-1155
Mailing Address - Fax:813-602-0216
Practice Address - Street 1:5011 CHANCELLOR ST NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3305
Practice Address - Country:US
Practice Address - Phone:305-393-2574
Practice Address - Fax:813-602-0216
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10522103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist