Provider Demographics
NPI:1033592589
Name:DEMETRIOU, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:DEMETRIOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4343
Mailing Address - Country:US
Mailing Address - Phone:631-858-0400
Mailing Address - Fax:
Practice Address - Street 1:356 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4343
Practice Address - Country:US
Practice Address - Phone:631-858-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307385363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health