Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dina Nicklas

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1003696600

Dina Nicklas is a Nurse Practitioner in Deer Park, New York. Qualified in 2023, 3 years ago. Practices as a sole proprietor. Licensed in New York.

Years since qualifying
3
Licensed in
NY
In the registry since
2023
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

84 Wright Ave
Deer Park, NY 11729-2808
Phone: (631) 241-5928
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 405355 (NY)

Record details

NPI number1003696600
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedOctober 2, 2023
Last updated in NPPESOctober 2, 2023
Certification dateOctober 2, 2023
Mailing address84 Wright Ave, Deer Park, NY 11729-2808

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Deer Park