Provider Demographics
NPI:1396320479
Name:SEFERSHAYAN, NICOLE (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SEFERSHAYAN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RALPH PL STE 304
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4416
Mailing Address - Country:US
Mailing Address - Phone:718-980-0188
Mailing Address - Fax:
Practice Address - Street 1:11 RALPH PL STE 304
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4416
Practice Address - Country:US
Practice Address - Phone:718-980-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002998231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist