Healthcare Provider Details

I. General information

NPI: 1619131430
Provider Name (Legal Business Name): NICOLE NEVADUNSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 ROCHAMBEAU CENTENNIAL WOMEN'S CENTER SUITE C
BRONX NY
10467-6110
US

IV. Provider business mailing address

1695 EASTCHESTER RD SUITE 602
BRONX NY
10461-2374
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4794
  • Fax:
Mailing address:
  • Phone: 718-405-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number230012
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: