MEDICARE: NASANDI NEQUANDI ROLLINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1083372312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASANDI NEQUANDI ROLLINS

Provider Business Mailing Address
First Line	:	73 MELROSE AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-2705
Country	:	US
Telephone Number	:	732-983-1835
Fax Number	:

Provider Business Practice Location Address
First Line	:	73 MELROSE AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-2705
Country	:	US
Telephone Number	:	732-983-1835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2021
Last Update Date	:	12/03/2021

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