Provider Demographics
NPI:1881246791
Name:SALIFOU, NICOLE CLAON
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CLAON
Last Name:SALIFOU
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 1:23486 SW 113TH PASS
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7156
Mailing Address - Country:US
Mailing Address - Phone:305-733-2278
Mailing Address - Fax:
Practice Address - Street 1:23486 SW 113TH PASS
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7156
Practice Address - Country:US
Practice Address - Phone:305-733-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA83465225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty