Provider Demographics
NPI:1659044717
Name:BRODY, NINA JAEL
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:JAEL
Last Name:BRODY
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 1:28141 KELLY JOHNSON PKWY
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5003
Mailing Address - Country:US
Mailing Address - Phone:661-306-9656
Mailing Address - Fax:
Practice Address - Street 1:28141 KELLY JOHNSON PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5003
Practice Address - Country:US
Practice Address - Phone:661-888-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist