Provider Demographics
NPI:1508510231
Name:CHOLAKIS, JEANETTE (NP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:CHOLAKIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WISHBONE LN
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1236
Mailing Address - Country:US
Mailing Address - Phone:917-593-9671
Mailing Address - Fax:
Practice Address - Street 1:39 BRENTWOOD RD STE 201
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8031
Practice Address - Country:US
Practice Address - Phone:631-968-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner