Provider Demographics
NPI:1356019913
Name:STEFANIDIS, NICHOLAS CHRISTOPHER (PA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:CHRISTOPHER
Last Name:STEFANIDIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:315 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2923
Mailing Address - Country:US
Mailing Address - Phone:516-487-5577
Mailing Address - Fax:
Practice Address - Street 1:315 E SHORE RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2923
Practice Address - Country:US
Practice Address - Phone:516-487-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant