Healthcare Provider Details

I. General information

NPI: 1033553003
Provider Name (Legal Business Name): NICOLE SESTITO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CHRISTY DR STE 207
CHADDS FORD PA
19317-9667
US

IV. Provider business mailing address

5 CHRISTY DR STE 207
CHADDS FORD PA
19317-9667
US

V. Phone/Fax

Practice location:
  • Phone: 484-841-6725
  • Fax: 888-732-8120
Mailing address:
  • Phone: 484-841-6725
  • Fax: 888-732-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS017428
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number36384
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00568600
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35SI00568600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: