Healthcare Provider Details

I. General information

NPI: 1568398352
Provider Name (Legal Business Name): MR. NICHOLAS OSCAR COLON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 SILVER CHARM TER
WESLEY CHAPEL FL
33544-1582
US

IV. Provider business mailing address

5028 SILVER CHARM TER
WESLEY CHAPEL FL
33544-1582
US

V. Phone/Fax

Practice location:
  • Phone: 908-938-1577
  • Fax:
Mailing address:
  • Phone: 908-938-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number106S00000X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: