Provider Demographics
NPI:1780234856
Name:CABALLERO, NICOLE FAY
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:FAY
Last Name:CABALLERO
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 1:621 SKYTOP RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13244-4416
Mailing Address - Country:US
Mailing Address - Phone:315-443-4485
Mailing Address - Fax:315-443-4431
Practice Address - Street 1:621 SKYTOP RD STE 1200
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-4416
Practice Address - Country:US
Practice Address - Phone:315-443-4485
Practice Address - Fax:315-443-4431
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP102641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist