Provider Demographics
NPI:1255065488
Name:SANTALUCIA, NICHOLAS DANIEL (LNP)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:DANIEL
Last Name:SANTALUCIA
Suffix:
Gender:M
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 E WEYBURN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2037
Mailing Address - Country:US
Mailing Address - Phone:804-519-9483
Mailing Address - Fax:
Practice Address - Street 1:1640 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2368
Practice Address - Country:US
Practice Address - Phone:855-444-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPENDING363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health