Provider Demographics
NPI:1811144587
Name:HERNANDEZ, NICOLE GONDAR (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:GONDAR
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4377
Mailing Address - Country:US
Mailing Address - Phone:305-418-7710
Mailing Address - Fax:305-418-7707
Practice Address - Street 1:12246 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7016
Practice Address - Country:US
Practice Address - Phone:954-517-8910
Practice Address - Fax:954-517-8903
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist