Healthcare Provider Details

I. General information

NPI: 1639500457
Provider Name (Legal Business Name): DANIA NICOLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CLINTON ST STE 601
HEMPSTEAD NY
11550-4282
US

IV. Provider business mailing address

11713 220TH ST
CAMBRIA HEIGHTS NY
11411-1608
US

V. Phone/Fax

Practice location:
  • Phone: 516-933-0485
  • Fax:
Mailing address:
  • Phone: 347-488-7083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number297214-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number695117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: