Provider Demographics
NPI:1386278216
Name:MERCALDO, NICHOLAS FRANCIS
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:FRANCIS
Last Name:MERCALDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ARCHDALE ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7825
Mailing Address - Country:US
Mailing Address - Phone:843-902-1911
Mailing Address - Fax:
Practice Address - Street 1:4871 SOCASTEE BLVD UNIT E
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7252
Practice Address - Country:US
Practice Address - Phone:843-293-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4381225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant