Provider Demographics
NPI:1255019790
Name:STAVRAKOS, PAMELA (PA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:STAVRAKOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 VAN WAGNER RD APT 1C
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1302
Mailing Address - Country:US
Mailing Address - Phone:718-490-6715
Mailing Address - Fax:
Practice Address - Street 1:672 STONELEIGH AVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-4634
Practice Address - Country:US
Practice Address - Phone:845-279-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant