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General NPI Number Information
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NPI Number | 1932519303
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Entity Type | Individual
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Provider Name | NIKOLE WYSOCKI
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Gender | Female
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 6405 OCTAGON DR APT 2C
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-6164
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Country | US
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Telephone | 804-973-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 400 SHERIDAN RD
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City | MELBOURNE
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State | FL
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Zip | 32901-3122
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133004416
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License Number State | VA
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