Nicole Alyssa Pellicciotto, MED, ABD

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

11642 Leehigh Drive
Fairfax, VA 22030-5640

Phone

(703) 819-4697

NPI assigned

May 2, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nicole Pellicciotto Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720200728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11642 LEEHIGH DRIVE",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305640",
            "telephone_number": "703-819-4697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11642 LEEHIGH DRIVE",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305640",
            "telephone_number": "703-819-4697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLICCIOTTO",
        "first_name": "NICOLE",
        "middle_name": "ALYSSA",
        "credential": "MED, ABD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEVELOPMENTAL",
            "identifier": "222Q00000X",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "PELLICCIOTTO",
            "credential": "MED, ABD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Developmental Therapist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Developmental Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.