Healthcare Provider Details

I. General information

NPI: 1740914514
Provider Name (Legal Business Name): NICHOLAS C DADDARIO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 HADDONFIELD RD STE 230
CHERRY HILL NJ
08002-2201
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 732-982-2888
  • Fax: 732-694-7622
Mailing address:
  • Phone: 732-982-2888
  • Fax: 732-694-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01340000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: