Individual
NICKEELA JENELLA AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BROADHOLLOW RD STE MELVILLE, MELVILLE, NY 11747-4822
(631) 385-7780
Mailing address
1 LAKE ST, MASSAPEQUA, NY 11758-5508
(631) 482-0665
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/22/2021
Last updated
12/22/2021
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