Provider Demographics
NPI:1184005134
Name:DEDOUSIS, AMALIA
Entity Type:Individual
Prefix:
First Name:AMALIA
Middle Name:
Last Name:DEDOUSIS
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 1:131 78TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2913
Mailing Address - Country:US
Mailing Address - Phone:917-974-2495
Mailing Address - Fax:
Practice Address - Street 1:131 78TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2913
Practice Address - Country:US
Practice Address - Phone:917-974-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist