Provider Demographics
NPI:1285421743
Name:PUKYS, NINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:PUKYS
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 SAFFRON PL
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9278
Mailing Address - Country:US
Mailing Address - Phone:216-272-2064
Mailing Address - Fax:
Practice Address - Street 1:1292 SAFFRON PL
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9278
Practice Address - Country:US
Practice Address - Phone:216-272-2064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist