Provider Demographics
NPI:1083147920
Name:SIKACZOWSKI, NICOLAS DEMETRIUS (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:DEMETRIUS
Last Name:SIKACZOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:STE 1300, 3RD FLOOR
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072
Mailing Address - Country:US
Mailing Address - Phone:786-503-4499
Mailing Address - Fax:786-685-2120
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:STE 1300, 3RD FLOOR
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072
Practice Address - Country:US
Practice Address - Phone:207-200-4789
Practice Address - Fax:786-685-2120
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEDO33442084P0800X, 2084P0804X
FLOS155902084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry