Healthcare Provider Details

I. General information

NPI: 1720732647
Provider Name (Legal Business Name): JUSTUS MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 VETERANS SQ
MEDIA PA
19063-3155
US

IV. Provider business mailing address

24 VETERANS SQ
MEDIA PA
19063-3155
US

V. Phone/Fax

Practice location:
  • Phone: 610-705-7520
  • Fax:
Mailing address:
  • Phone: 610-705-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHERRY NYKIEL
Title or Position: OWNER AND CHIEF MEDICAL OFFICER
Credential: MD
Phone: 610-705-7520