Basic Information
| Provider Information | |||||||||
| NPI: | 1033555438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOL | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.S. PA-C; CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 SEA SPRAY DR | ||||||||
| Address2: | |||||||||
| City: | CENTERPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117211633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315136554 | ||||||||
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| Practice Location | |||||||||
| Address1: | 622 W 168TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123052500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 06/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 022439-1 | NY | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 363A00000X | 023317 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.