Provider Demographics
NPI:1598221731
Name:KAMBANIS, ELEFTHERIA
Entity Type:Individual
Prefix:MRS
First Name:ELEFTHERIA
Middle Name:
Last Name:KAMBANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEFTY
Other - Middle Name:
Other - Last Name:NEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 PLUM WOOD CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8373
Mailing Address - Country:US
Mailing Address - Phone:916-298-4055
Mailing Address - Fax:
Practice Address - Street 1:108 BELFAIR RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8040
Practice Address - Country:US
Practice Address - Phone:803-629-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29716235Z00000X
235Z00000X
SC7686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist