Provider Demographics
NPI:1205678984
Name:NICHOLAS, SERIAH B
Entity type:Individual
Prefix:
First Name:SERIAH
Middle Name:B
Last Name:NICHOLAS
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 1:1687 SEMORAN NORTH CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1485
Mailing Address - Country:US
Mailing Address - Phone:954-805-8463
Mailing Address - Fax:
Practice Address - Street 1:1687 SEMORAN NORTH CIR APT 101
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1485
Practice Address - Country:US
Practice Address - Phone:904-775-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician