Provider Demographics
NPI:1689348013
Name:SKULIKIDIS, PANTELIS (FNP)
Entity Type:Individual
Prefix:
First Name:PANTELIS
Middle Name:
Last Name:SKULIKIDIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BELLE TERRE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2500
Mailing Address - Country:US
Mailing Address - Phone:631-524-5960
Mailing Address - Fax:
Practice Address - Street 1:620 BELLE TERRE RD STE 2
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2500
Practice Address - Country:US
Practice Address - Phone:631-524-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347957-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty