Nicole V Balladares, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

8 W Shore Rd
Bay Shore, NY 11706-8211

Phone

(631) 835-5667

NPI assigned

Aug 19, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1566172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1922655653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 W SHORE RD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 W SHORE RD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068211",
            "telephone_number": "631-835-5667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLADARES",
        "first_name": "NICOLE",
        "middle_name": "V",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-19",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shernetta Marva Bailey, RN
• Dewan Chand Bajaj, LMSW
• Tanveer Akhtar Bajwa, M. D.
• Taibat Bakare
• Kimberly Rose Balducci, LMSW
• Manju Kaur Balu, PHARMD
• Marie Josette Balzora X
• Alexandria Bamonte, CCC-SLP, TSSLD
• Danielle Banducci
• Jenna Bannon, MS, RD, CDN

• Physician Assistant in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.