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General NPI Number Information
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NPI Number | 1255638201
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Entity Type | Individual
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Provider Name | MRS. NICOLE D'AMICO-STONBRAKER
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Gender | Female
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Dates
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Enumeration Date | 02/26/2011
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 436 WILLIS AVE 3RD FLOOR
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City | WILLISTON PARK
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State | NY
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Zip | 11596-2298
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Country | US
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Telephone | 516-741-0729
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Fax |
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Provider Business Mailing Address
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Address Line | 43 ISLAND TRAIL
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City | MT. SINAI
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State | NY
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Zip | 11766
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 020730
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License Number State | NY
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