Provider Demographics
NPI:1104559657
Name:JAVAHERI, NICOLE (CF-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JAVAHERI
Suffix:
Gender:F
Credentials:CF-SLP, TSSLD
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:JAVAHERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 SADDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1151
Mailing Address - Country:US
Mailing Address - Phone:516-606-7888
Mailing Address - Fax:
Practice Address - Street 1:15 SADDLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1151
Practice Address - Country:US
Practice Address - Phone:516-606-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist