Provider Demographics
NPI:1659690485
Name:SANTIAGO DRAKATOS, ALEXIS CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:CHRISTINE
Last Name:SANTIAGO DRAKATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:CHRISTINE
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-0650
Mailing Address - Fax:
Practice Address - Street 1:260 E MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2982
Practice Address - Country:US
Practice Address - Phone:631-979-7222
Practice Address - Fax:631-265-7518
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270313208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics