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General NPI Number Information
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NPI Number | 1275241192
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Entity Type | Individual
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Provider Name | NICOLE MAYER
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Gender | Female
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 974 SW 159TH LN
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-5034
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Country | US
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Telephone | 954-918-2839
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Fax | 866-219-8489
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Provider Business Mailing Address
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Address Line | 828 NE 19TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3081
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Country | US
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Telephone | 516-974-5470
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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 | SA14566
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License Number State | FL
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