Healthcare Provider Details

I. General information

NPI: 1811631195
Provider Name (Legal Business Name): NIKOLAS SEAN MIKUS AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2022
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 LINDEN DR STE 106
WINCHESTER VA
22601-6901
US

IV. Provider business mailing address

142 LINDEN DR STE 106
WINCHESTER VA
22601-6901
US

V. Phone/Fax

Practice location:
  • Phone: 540-722-7282
  • Fax:
Mailing address:
  • Phone: 540-722-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101002525
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001877
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: