Healthcare Provider Details

I. General information

NPI: 1205760535
Provider Name (Legal Business Name): NIA SLAUGHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 ROUTE 17K STE 107A
NEWBURGH NY
12550-8358
US

IV. Provider business mailing address

263 ROUTE 17K STE 107A
NEWBURGH NY
12550-8358
US

V. Phone/Fax

Practice location:
  • Phone: 845-200-9230
  • Fax: 845-622-3504
Mailing address:
  • Phone: 845-200-9230
  • Fax: 845-622-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: