Provider Demographics
NPI:1811184062
Name:NUSBAUM, NANCY H (MCD CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:H
Last Name:NUSBAUM
Suffix:
Gender:F
Credentials:MCD CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 N HALIFAX DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-4166
Mailing Address - Country:US
Mailing Address - Phone:334-750-2513
Mailing Address - Fax:
Practice Address - Street 1:893 N HALIFAX DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-4166
Practice Address - Country:US
Practice Address - Phone:334-750-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890008700Medicaid
FL000180400Medicaid