Provider Demographics
NPI:1578189213
Name:VAFIADIS, CHRISTINA DIMITRA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIMITRA
Last Name:VAFIADIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W SUFFOLK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2156
Mailing Address - Country:US
Mailing Address - Phone:631-582-2228
Mailing Address - Fax:
Practice Address - Street 1:45 W SUFFOLK AVE FL 2
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2156
Practice Address - Country:US
Practice Address - Phone:631-582-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant