Provider Demographics
NPI:1710524459
Name:SANDULLI, NICHOLAS THOMAS (CRNP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:SANDULLI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:720 FORDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15226-2120
Mailing Address - Country:US
Mailing Address - Phone:412-401-4731
Mailing Address - Fax:
Practice Address - Street 1:3600 MEYRAN @FORBES
Practice Address - Street 2:FORBES TOWER SUITE 9055
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-647-4618
Practice Address - Fax:412-802-6923
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.446603163WE0003X
PASP022242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency