Provider Demographics
NPI:1124228002
Name:MICHAELIDES, STEPHANIE (AUD, CCC-A, FAAA)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:MICHAELIDES
Suffix:
Gender:F
Credentials:AUD, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4566
Mailing Address - Country:US
Mailing Address - Phone:203-298-9810
Mailing Address - Fax:
Practice Address - Street 1:965 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4566
Practice Address - Country:US
Practice Address - Phone:203-459-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000456231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1023272598Medicare NSC