Healthcare Provider Details

I. General information

NPI: 1598672107
Provider Name (Legal Business Name): NICOLE ARISTIZABAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MAGDA

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SOUND RD STE 200
HOLLY RIDGE NC
28445-7813
US

IV. Provider business mailing address

1013 TERRACES LN
HAMPSTEAD NC
28443-7264
US

V. Phone/Fax

Practice location:
  • Phone: 973-713-1605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30004658
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00950400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: