Provider Demographics
NPI:1265684310
Name:ANZALONE, NICOLE MARIE (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:ANZALONE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:SANPETRINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:5639 WEST GENESEE ST.
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031
Mailing Address - Country:US
Mailing Address - Phone:315-468-6888
Mailing Address - Fax:315-468-6892
Practice Address - Street 1:5639 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1250
Practice Address - Country:US
Practice Address - Phone:315-468-6888
Practice Address - Fax:315-468-6892
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002209231H00000X
NY57002209237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist