Provider Demographics
NPI:1659606937
Name:IOANNIDES, STAVROULA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STAVROULA
Middle Name:
Last Name:IOANNIDES
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:STAVROULA
Other - Middle Name:
Other - Last Name:BOUNDOURIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1750 MARINE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4452
Mailing Address - Country:US
Mailing Address - Phone:347-743-5033
Mailing Address - Fax:
Practice Address - Street 1:420 95TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7404
Practice Address - Country:US
Practice Address - Phone:718-680-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist