Nicole Lee Ambrose | Staten Island, NY • PECOS Search

Nicole Lee Ambrose

Speech-Language Pathologist

Speech, Language and Hearing Service Providers

1000 South Avenue, Staten Island, NY 10314-3409

(718) 477-0961 (917) 974-2198

PECOS Enrollment

Based on the most recent information from CMS, provider Nicole Lee Ambrose does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1003169095
Provider Type
Individual
Full Name
Ambrose, Nicole Lee
Title
Ms.

Gender
Female
Sole Proprietor
No
Enumeration Date
10/16/2012
Last Updated
6/3/2020

Contact Information

Practice Location

1000 South Avenue, Staten Island, NY 10314-3409

(718) 761-1643

Mailing Location

350 Richmond Ter Apt 3c, Staten Island, NY 10301-1518

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 235Z00000X Primary	Description Speech-Language Pathologist Speech, Language and Hearing Service Providers	License 021832 New York