Healthcare Provider Details

I. General information

NPI: 1689555302
Provider Name (Legal Business Name): NICOLE BRITTANY NEYTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 W 5TH ST APT 13C
BROOKLYN NY
11224-3923
US

IV. Provider business mailing address

2935 W 5TH ST APT 13C
BROOKLYN NY
11224-3923
US

V. Phone/Fax

Practice location:
  • Phone: 347-525-6566
  • Fax:
Mailing address:
  • Phone: 347-525-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1689555302
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1689555302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: