Provider Demographics
NPI:1487493425
Name:LELLO, NICOLE DEBORAH (RN, NP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DEBORAH
Last Name:LELLO
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E NEW YORK AVE APT 11J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4623
Mailing Address - Country:US
Mailing Address - Phone:347-951-4612
Mailing Address - Fax:
Practice Address - Street 1:2010 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-3163
Practice Address - Country:US
Practice Address - Phone:718-928-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY727218163W00000X
NY406080363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse