MEDICARE: SANDALWOOD MENTAL HEALTH, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1710662341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDALWOOD MENTAL HEALTH, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1081
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-4081
Country	:	US
Telephone Number	:	803-809-3184
Fax Number	:	803-615-4662

Provider Business Practice Location Address
First Line	:	244 LATITUDE LN STE 104
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8125
Country	:	US
Telephone Number	:	803-809-3184
Fax Number	:	803-615-4662

Authorized Official
Title or Position	:	CEO
Name	:	PETER A. BERTELLI
Credential	:	APRN
Telephone Number	:	508-538-3165

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2026

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