Provider Demographics
NPI:1619306081
Name:STATHOPOULOS, TANYA (AUD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:STATHOPOULOS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2297 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3666
Mailing Address - Country:US
Mailing Address - Phone:631-585-1212
Mailing Address - Fax:631-585-1006
Practice Address - Street 1:2297 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3666
Practice Address - Country:US
Practice Address - Phone:631-585-1212
Practice Address - Fax:631-585-1006
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002503-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist