Healthcare Provider Details

I. General information

NPI: 1699244038
Provider Name (Legal Business Name): NICOLE FELIX-RENOIS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7649 HEWLETT ST
NEW HYDE PARK NY
11040-1429
US

IV. Provider business mailing address

105 HUNGRY HARBOR RD
VALLEY STREAM NY
11581-2537
US

V. Phone/Fax

Practice location:
  • Phone: 212-388-1903
  • Fax:
Mailing address:
  • Phone: 516-596-7583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number753487
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: