Individual
NICOLE RYANN MIHALIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1 SCOUTING BLVD, MEDFORD, NY 11763-2220
(631) 297-3201
Mailing address
1 SCOUTING BLVD, MEDFORD, NY 11763-2220
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1179261171
NY
Other
Enumeration date
10/19/2017
Last updated
10/19/2017
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