Healthcare Provider Details

I. General information

NPI: 1669392494
Provider Name (Legal Business Name): NICOLE DENISE DIAZ-MACKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W PALMETTO PARK RD STE 201
BOCA RATON FL
33433-3430
US

IV. Provider business mailing address

5381 W HILLSBORO BLVD APT 306
COCONUT CREEK FL
33073-4581
US

V. Phone/Fax

Practice location:
  • Phone: 561-376-2573
  • Fax:
Mailing address:
  • Phone: 617-909-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: