MEDICARE: REGINA NICOLOSI M.S. - 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	SL011862	PA

General Provider Information

NPI Number	:	1821408378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA NICOLOSI M.S. - SLP

Provider Business Mailing Address
First Line	:	297 HOLLY HILL RD
Second Line	:
City	:	RICHBORO
State	:	PA
Zip	:	18954-1948
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	297 HOLLY HILL RD
Second Line	:
City	:	RICHBORO
State	:	PA
Zip	:	18954-1948
Country	:	US
Telephone Number	:	215-605-4773
Fax Number	:

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

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	05/06/2014

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