Provider Demographics
NPI:1295040871
Name:KYRIACOU, KATHERINE ANNASTASIA (RN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNASTASIA
Last Name:KYRIACOU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 SADDLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4824
Mailing Address - Country:US
Mailing Address - Phone:631-627-4791
Mailing Address - Fax:
Practice Address - Street 1:1706 SADDLE ROCK RD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4824
Practice Address - Country:US
Practice Address - Phone:631-627-4791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22693318163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse