MEDICARE: NICOLE DICICCO

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	133V00000X	Registered Dietitian	LD.11154	OH

General Provider Information

NPI Number	:	1699646208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DICICCO

Provider Business Mailing Address
First Line	:	5975 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-2902
Country	:	US
Telephone Number	:	216-633-9885
Fax Number	:

Provider Business Practice Location Address
First Line	:	5975 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-2902
Country	:	US
Telephone Number	:	216-633-9885
Fax Number	:

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

Provider Enumeration Date	:	09/16/2025
Last Update Date	:	09/16/2025

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Directions to “ NICOLE DICICCO ” Practice Location

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