Healthcare Provider Details

I. General information

NPI: 1265772826
Provider Name (Legal Business Name): PATRICIA SCALLY NICOLETTI MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FULTON AVE
HEMPSTEAD NY
11550-3633
US

IV. Provider business mailing address

40 FULTON AVE
HEMPSTEAD NY
11550-3633
US

V. Phone/Fax

Practice location:
  • Phone: 516-292-7111
  • Fax:
Mailing address:
  • Phone: 516-292-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number580006904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: