MEDICARE: NIKOLE WYSOCKI

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	103K00000X	Behavior Analyst	0133004416	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932519303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLE WYSOCKI

Provider Business Mailing Address
First Line	:	400 SHERIDAN RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6405 OCTAGON DR APT 2C
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6164
Country	:	US
Telephone Number	:	804-973-3200
Fax Number	:

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

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	09/30/2025

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Directions to “ NIKOLE WYSOCKI ” Practice Location

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