Provider Demographics
NPI:1417294588
Name:NASTASI, ATHENA NICKAS (LAC)
Entity Type:Individual
Prefix:MS
First Name:ATHENA
Middle Name:NICKAS
Last Name:NASTASI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PRIVATE RD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1124
Mailing Address - Country:US
Mailing Address - Phone:517-779-7521
Mailing Address - Fax:
Practice Address - Street 1:8 PRIVATE RD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-1124
Practice Address - Country:US
Practice Address - Phone:517-779-7521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004845171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist