Basic Information
| Provider Information | |||||||||
| NPI: | 1679513154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESQUENAZI | ||||||||
| FirstName: | NADINE | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | HIS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | POLLINO | ||||||||
| OtherFirstName: | NADINE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2510 E SUNSET RD | ||||||||
| Address2: | UNIT 5-260 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891203511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027980113 | ||||||||
| FaxNumber: | 8662915242 | ||||||||
| Practice Location | |||||||||
| Address1: | 269 S. FEDERAL HWY. | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334414161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544262500 | ||||||||
| FaxNumber: | 9544263797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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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 | 237700000X | 2665 | FL | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | AS2665 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 610202600 | 05 | FL | MEDICAID |