Provider Demographics
NPI:1912500224
Name:NICCHI, ROUDELINE (DO)
Entity Type:Individual
Prefix:
First Name:ROUDELINE
Middle Name:
Last Name:NICCHI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2451
Mailing Address - Country:US
Mailing Address - Phone:631-994-9619
Mailing Address - Fax:516-804-9454
Practice Address - Street 1:838 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2451
Practice Address - Country:US
Practice Address - Phone:631-994-9619
Practice Address - Fax:516-804-9454
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214018246ZN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZN0300XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherNephrology