Provider Demographics
NPI:1255703724
Name:STAIKOVA, EKATERINA
Entity type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:
Last Name:STAIKOVA
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 1:7303 CALIBRE PARK DR
Mailing Address - Street 2:#304
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5673
Mailing Address - Country:US
Mailing Address - Phone:347-610-9192
Mailing Address - Fax:
Practice Address - Street 1:12 EXECUTIVE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30329-2206
Practice Address - Country:US
Practice Address - Phone:404-778-5943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4850103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist