Provider Demographics
NPI:1417166810
Name:STAMATELATOS, APHRODITE (RPA-C)
Entity Type:Individual
Prefix:
First Name:APHRODITE
Middle Name:
Last Name:STAMATELATOS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 N WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1515
Mailing Address - Country:US
Mailing Address - Phone:516-420-9042
Mailing Address - Fax:
Practice Address - Street 1:4 DOROTHY GATE
Practice Address - Street 2:
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3521
Practice Address - Country:US
Practice Address - Phone:516-795-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant