Provider Demographics
NPI:1528632270
Name:SCIARRA, NICOLE (RN, OMT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:SCIARRA
Suffix:
Gender:F
Credentials:RN, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1584
Mailing Address - Country:US
Mailing Address - Phone:203-577-7383
Mailing Address - Fax:
Practice Address - Street 1:315 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2547
Practice Address - Country:US
Practice Address - Phone:203-806-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT116153163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty