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General NPI Number Information
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NPI Number | 1518504018
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Entity Type | Individual
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Provider Name | NICOLE MOAWAD
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Gender | Female
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 131 SUNNYSIDE BLVD STE 100C
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City | PLAINVIEW
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State | NY
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Zip | 11803-1539
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Country | US
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Telephone | 516-340-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 93 HALF HOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-3206
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Country | US
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Telephone | 631-316-2374
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 312345
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 711476
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License Number State | NY
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