Healthcare Provider Details

I. General information

NPI: 1134070709
Provider Name (Legal Business Name): NICOLE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18802 64TH AVE APT 10K
FRESH MEADOWS NY
11365-3811
US

IV. Provider business mailing address

18802 64TH AVE APT 10K
FRESH MEADOWS NY
11365-3811
US

V. Phone/Fax

Practice location:
  • Phone: 718-570-5415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: