Individual
CARLY NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
136 HELEN AVE, BLASDELL, NY 14219-1647
(716) 870-4732
Mailing address
87 SANDRA PL, HAMBURG, NY 14075-5306
(716) 870-4732
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/18/2013
Last updated
10/28/2013
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