MEDICARE: MRS. NICOLE AMBER PIAZZA SLP

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	015139	NY

General Provider Information

NPI Number	:	1750504791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE AMBER PIAZZA SLP

Provider Business Mailing Address
First Line	:	26 CAROL AVE
Second Line	:
City	:	FREDONIA
State	:	NY
Zip	:	14063-1208
Country	:	US
Telephone Number	:	716-785-6245
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 CENTRAL AVE
Second Line	:	W123 THOMPSON HALL
City	:	FREDONIA
State	:	NY
Zip	:	14063-1127
Country	:	US
Telephone Number	:	716-673-3202
Fax Number	:	716-673-3235

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	02/20/2013

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