Provider Demographics
NPI:1811631195
Name:MIKUS, NIKOLAS SEAN (AUD)
Entity type:Individual
Prefix:
First Name:NIKOLAS
Middle Name:SEAN
Last Name:MIKUS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 LINDEN DR STE 106
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6901
Mailing Address - Country:US
Mailing Address - Phone:540-722-7282
Mailing Address - Fax:
Practice Address - Street 1:142 LINDEN DR STE 106
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6901
Practice Address - Country:US
Practice Address - Phone:540-722-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002525237700000X
VA2201001877231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist