MEDICARE: NICOLETTE PULLO M.S, SLP-CF

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	027126	NY

General Provider Information

NPI Number	:	1811345333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLETTE PULLO M.S, SLP-CF

Provider Business Mailing Address
First Line	:	25522 74TH AVE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1114
Country	:	US
Telephone Number	:	516-680-9496
Fax Number	:

Provider Business Practice Location Address
First Line	:	25522 74TH AVE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1114
Country	:	US
Telephone Number	:	516-680-9496
Fax Number	:

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

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	09/22/2017

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Directions to “ NICOLETTE PULLO M.S, SLP-CF” Practice Location

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