Provider Demographics
NPI:1386166643
Name:MENDEZ, NICHOLAS LEE (MA, ATC, LAT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LEE
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5391 FERRIS AVE
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-5046
Mailing Address - Country:US
Mailing Address - Phone:239-770-4778
Mailing Address - Fax:
Practice Address - Street 1:5391 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-5046
Practice Address - Country:US
Practice Address - Phone:239-770-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer