=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487206991
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE NICOLEAU NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2019
-----------------------------------------------------
Last Update Date | 04/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2570 HEMPSTEAD TPKE UNIT 2
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-2146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-548-0600
-----------------------------------------------------
Fax | 516-548-0605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2570 HEMPSTEAD TPKE UNIT 2
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-2146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-548-0600
-----------------------------------------------------
Fax | 844-689-3254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 309270
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------