MEDICARE: MS. NICOLE CHRISTIN SCALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator	431654101	NY

General Provider Information

NPI Number	:	1093148637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE CHRISTIN SCALA

Provider Business Mailing Address
First Line	:	18 BRAGG DR
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2304
Country	:	US
Telephone Number	:	631-220-6755
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 BRAGG DR
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2304
Country	:	US
Telephone Number	:	631-220-6755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	08/19/2013

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