Provider Demographics
NPI:1083847230
Name:PANAGAKOS LAMIA, EVELYN (MS,CCC-L/SLP)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:PANAGAKOS LAMIA
Suffix:
Gender:F
Credentials:MS,CCC-L/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 MILL RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1841
Mailing Address - Country:US
Mailing Address - Phone:516-797-0389
Mailing Address - Fax:516-797-0389
Practice Address - Street 1:3931 MILL RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1841
Practice Address - Country:US
Practice Address - Phone:516-797-0389
Practice Address - Fax:516-797-0389
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000857-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000857-1OtherNYS LICENSE TO PRACTICE SPEECH LANGUAGE PATHOLOGY
00404111OtherAMERICAN SPEECH HEARING LANGUAGE ASSOCIATION (ASHA)