Healthcare Provider Details

I. General information

NPI: 1497250633
Provider Name (Legal Business Name): NICOLE M BUCCIERI-ALDRIDGE SPEECH-LANGUAGE PATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 THIMBLE SHOALS BLVD STE 4-C
NEWPORT NEWS VA
23606
US

IV. Provider business mailing address

729 THIMBLE SHOALS BLVD STE 4-C
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-2932
  • Fax: 757-873-8780
Mailing address:
  • Phone: 757-873-2932
  • Fax: 757-873-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: