Healthcare Provider Details

I. General information

NPI: 1740922335
Provider Name (Legal Business Name): NIKELLE SYBROWSKY M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19490 S 190TH DR
QUEEN CREEK AZ
85142-6887
US

IV. Provider business mailing address

19490 S 190TH DR
QUEEN CREEK AZ
85142-6887
US

V. Phone/Fax

Practice location:
  • Phone: 480-939-5242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP13986
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14296898
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: