Provider Demographics
NPI:1881412609
Name:RENDOR, NINA RICCI
Entity type:Individual
Prefix:
First Name:NINA RICCI
Middle Name:
Last Name:RENDOR
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 1:144 GROVE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2324
Mailing Address - Country:US
Mailing Address - Phone:516-367-0687
Mailing Address - Fax:516-200-0106
Practice Address - Street 1:144 GROVE AVE STE 3
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2324
Practice Address - Country:US
Practice Address - Phone:516-367-0687
Practice Address - Fax:516-200-0106
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily