Provider Demographics
NPI:1205361938
Name:NICOLAS, ABIGAIL NADIA CANARE
Entity type:Individual
Prefix:
First Name:ABIGAIL NADIA
Middle Name:CANARE
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 43RD AVE
Mailing Address - Street 2:APT 3K
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4497
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5005 43RD AVE
Practice Address - Street 2:APT 3K
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4497
Practice Address - Country:US
Practice Address - Phone:718-683-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist