Provider Demographics
NPI:1366959157
Name:PASKALIDES, NICOLE C
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:PASKALIDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 W END AVE APT PH3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6138
Mailing Address - Country:US
Mailing Address - Phone:914-874-4799
Mailing Address - Fax:
Practice Address - Street 1:4102 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3008
Practice Address - Country:US
Practice Address - Phone:718-547-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W105433144OtherAETNA