Provider Demographics
NPI:1346519113
Name:KEISIDIS, ANASTASIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:
Last Name:KEISIDIS
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 1:3 TOWN PUMP CIR
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-9734
Mailing Address - Country:US
Mailing Address - Phone:585-594-3155
Mailing Address - Fax:
Practice Address - Street 1:139 FAIRBANKS RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14428-9782
Practice Address - Country:US
Practice Address - Phone:585-293-4541
Practice Address - Fax:585-293-4513
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY455357163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool