Healthcare Provider Details

I. General information

NPI: 1679484505
Provider Name (Legal Business Name): NICOLE DE LEONARDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3667 ILLONA LN
OCEANSIDE NY
11572-5901
US

IV. Provider business mailing address

3667 ILLONA LN
OCEANSIDE NY
11572-5901
US

V. Phone/Fax

Practice location:
  • Phone: 516-996-1345
  • Fax:
Mailing address:
  • Phone: 516-996-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number559561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: