Provider Demographics
NPI:1154443521
Name:DEMETRIOU, NEKTARIOS STAVROS (DO)
Entity Type:Individual
Prefix:DR
First Name:NEKTARIOS
Middle Name:STAVROS
Last Name:DEMETRIOU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:2649 WINDGUARD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7358
Practice Address - Country:US
Practice Address - Phone:813-723-1303
Practice Address - Fax:813-723-1304
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30282OtherBCBS
FLNH718OtherMEDICARE
FL000431100Medicaid
FLP01202208OtherR&R MEDICARE