MEDICARE: MRS. NICOLE NUNEZ MS CCC-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	013871	NY

General Provider Information

NPI Number	:	1790933000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE NUNEZ MS CCC-SLP

Provider Business Mailing Address
First Line	:	20 RIVER TER APT 3N
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10282-1205
Country	:	US
Telephone Number	:	917-930-8741
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 5TH AVE APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-7604
Country	:	US
Telephone Number	:	917-930-8741
Fax Number	:

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

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	03/22/2019

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