MEDICARE: NUKLEO-SYD LLC

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	235Z00000X	Speech-Language Pathologist	SP-1142	NV

General Provider Information

NPI Number	:	1861724684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUKLEO-SYD LLC

Provider Business Mailing Address
First Line	:	5575 SIMMONS ST
Second Line	:	SUITE 1-217
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-9009
Country	:	US
Telephone Number	:	702-979-4268
Fax Number	:	866-587-9165

Provider Business Practice Location Address
First Line	:	1333 N. BUFFALO DR.
Second Line	:	260
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3637
Country	:	US
Telephone Number	:	702-979-4268
Fax Number	:	702-979-1336

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	MR. CHRISTOPHER BORSELLINO
Credential	:	CCC-SLP
Telephone Number	:	702-979-4268

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	07/21/2022

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Directions to “NUKLEO-SYD LLC ” Practice Location

Language	Start Address	Practice Location

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