Provider Demographics
NPI:1073975074
Name:ATHANASATOS, ANTIGONE (DO)
Entity Type:Individual
Prefix:
First Name:ANTIGONE
Middle Name:
Last Name:ATHANASATOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10537 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2293
Mailing Address - Country:US
Mailing Address - Phone:727-376-8404
Mailing Address - Fax:727-674-2181
Practice Address - Street 1:10537 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-2293
Practice Address - Country:US
Practice Address - Phone:727-376-8404
Practice Address - Fax:727-674-2181
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16213208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics