Provider Demographics
NPI:1013780923
Name:D'AGOSTINO, NICOLE (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BAY 43RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4405
Mailing Address - Country:US
Mailing Address - Phone:917-628-9508
Mailing Address - Fax:
Practice Address - Street 1:1075 OCEAN VIEW AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5405
Practice Address - Country:US
Practice Address - Phone:718-891-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist