Provider Demographics
NPI:1942384151
Name:DORITY, NICOLE MERCALDO (DPT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MERCALDO
Last Name:DORITY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RAE
Other - Last Name:MERCALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:130B GROVE ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3668
Practice Address - Country:US
Practice Address - Phone:860-354-7605
Practice Address - Fax:860-355-0089
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8380225100000X
CT008351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist