Provider Demographics
NPI:1689555302
Name:NEYTOR, NICOLE BRITTANY
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRITTANY
Last Name:NEYTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 W 5TH ST APT 13C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3923
Mailing Address - Country:US
Mailing Address - Phone:347-525-6566
Mailing Address - Fax:
Practice Address - Street 1:2935 W 5TH ST APT 13C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3923
Practice Address - Country:US
Practice Address - Phone:347-525-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty