Provider Demographics
NPI:1083436612
Name:SRISKANDA, NICOLE (CHT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SRISKANDA
Suffix:
Gender:
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 UNION VALLEY RD
Mailing Address - Street 2:APPT D
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-3031
Mailing Address - Country:US
Mailing Address - Phone:347-644-4896
Mailing Address - Fax:
Practice Address - Street 1:169 BARD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1609
Practice Address - Country:US
Practice Address - Phone:347-644-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256644209171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach