Healthcare Provider Details

I. General information

NPI: 1649083262
Provider Name (Legal Business Name): NICOLE DANIELLE A YEE-NICHOLSON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2281 SW 129TH AVE
MIRAMAR FL
33027-2652
US

IV. Provider business mailing address

15711 SW 20TH ST
MIRAMAR FL
33027-4204
US

V. Phone/Fax

Practice location:
  • Phone: 954-998-6535
  • Fax:
Mailing address:
  • Phone: 954-707-7753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: