Healthcare Provider Details

I. General information

NPI: 1265532667
Provider Name (Legal Business Name): NICOLE MARIE AUGERI M.A.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

IV. Provider business mailing address

1413 WEBER ST
ORLANDO FL
32803-3337
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-7430
  • Fax:
Mailing address:
  • Phone: 407-247-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA7928
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberSA7928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: