MEDICARE: DR. THALES DE NARDO

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	235Z00000X	Speech-Language Pathologist	SL013062	PA

General Provider Information

NPI Number	:	1154801777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THALES DE NARDO

Provider Business Mailing Address
First Line	:	1712 LOMBARD ST APT A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 LOMBARD ST APT A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1519
Country	:	US
Telephone Number	:	330-475-3173
Fax Number	:

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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Directions to “ DR. THALES DE NARDO ” Practice Location

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