MEDICARE: NICOLE C PASKALIDES

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W105433144	OTHER		AETNA

General Provider Information

NPI Number	:	1366959157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE C PASKALIDES

Provider Business Mailing Address
First Line	:	393 W END AVE APT PH3C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6138
Country	:	US
Telephone Number	:	914-874-4799
Fax Number	:

Provider Business Practice Location Address
First Line	:	4102 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3008
Country	:	US
Telephone Number	:	718-547-0501
Fax Number	:

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

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	01/03/2018

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Directions to “ NICOLE C PASKALIDES ” Practice Location

Language	Start Address	Practice Location

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