Provider Demographics
NPI:1396958021
Name:NICHOLS, TASIANA
Entity type:Individual
Prefix:
First Name:TASIANA
Middle Name:
Last Name:NICHOLS
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:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:TALLMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10982-0426
Mailing Address - Country:US
Mailing Address - Phone:186-698-6011
Mailing Address - Fax:
Practice Address - Street 1:18 FLETCHER RD
Practice Address - Street 2:APT. E
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3220
Practice Address - Country:US
Practice Address - Phone:914-837-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist