Healthcare Provider Details

I. General information

NPI: 1083101224
Provider Name (Legal Business Name): FELICIA NICOLAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E ECKERSON RD
SPRING VALLEY NY
10977-3014
US

IV. Provider business mailing address

16 ALEXANDER AVE
SPRING VALLEY NY
10977-2343
US

V. Phone/Fax

Practice location:
  • Phone: 845-426-2569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number061020-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: