Healthcare Provider Details

I. General information

NPI: 1710524459
Provider Name (Legal Business Name): NICHOLAS THOMAS SANDULLI CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 10/26/2021
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MEYRAN @FORBES FORBES TOWER SUITE 9055
PITTSBURGH PA
15213
US

IV. Provider business mailing address

720 FORDHAM AVE
PITTSBURGH PA
15226-2120
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-4618
  • Fax: 412-802-6923
Mailing address:
  • Phone: 412-401-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN.446603
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022242
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: