Active NPI
Nicolina Marie Fedele, PH.D.
- Clinical Psychologist
- Wayland, MA
National Provider Identifier
1316901911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3522
- Practice address
- 36 Stonebridge Rd
Wayland, MA 01778-3023 - Phone
- (508) 655-4517
- Fax
- (508) 655-4517
- NPI assigned
- Apr 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3522 | MA | Primary |
Addresses
Primary practice location
36 Stonebridge Rd
Wayland, MA 01778-3023
Mailing address
36 Stonebridge Rd
Wayland, MA 01778-3023
Phone (508) 655-4517
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 718017 | Other | MA | TUFTS |
| 644665 | Other | MA | HPHC |
| W03457 | Other | MA | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2020 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3522 | MA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319155200000",
"number": "1316901911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 STONEBRIDGE RD",
"city": "WAYLAND",
"state": "MA",
"postal_code": "017783023",
"telephone_number": "508-655-4517",
"fax_number": "508-655-4517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 STONEBRIDGE RD",
"city": "WAYLAND",
"state": "MA",
"postal_code": "017783023",
"telephone_number": "508-655-4517",
"fax_number": "508-655-4517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDELE",
"first_name": "NICOLINA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-12",
"last_updated": "2011-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "3522",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "718017",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPHC",
"identifier": "644665",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "W03457",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wayland, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.