Provider Demographics
NPI:1013570530
Name:GIALALIDIS, KONSTANDINA ANGELA (LAC)
Entity Type:Individual
Prefix:
First Name:KONSTANDINA
Middle Name:ANGELA
Last Name:GIALALIDIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3053
Mailing Address - Country:US
Mailing Address - Phone:860-977-4837
Mailing Address - Fax:
Practice Address - Street 1:1218 NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3053
Practice Address - Country:US
Practice Address - Phone:860-977-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT634171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist