Provider Demographics
NPI:1821419573
Name:VAKALOPOULOS, JACKELYN
Entity Type:Individual
Prefix:MS
First Name:JACKELYN
Middle Name:
Last Name:VAKALOPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3897
Mailing Address - Country:US
Mailing Address - Phone:917-731-4060
Mailing Address - Fax:
Practice Address - Street 1:2016 18TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3897
Practice Address - Country:US
Practice Address - Phone:917-731-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency