Provider Demographics
NPI:1265141030
Name:NICOLAOU, ATHINA (NP)
Entity type:Individual
Prefix:
First Name:ATHINA
Middle Name:
Last Name:NICOLAOU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ATHINA
Other - Middle Name:
Other - Last Name:SALANDRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:64 77TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2919
Mailing Address - Country:US
Mailing Address - Phone:718-614-4128
Mailing Address - Fax:
Practice Address - Street 1:3607 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4366
Practice Address - Country:US
Practice Address - Phone:718-675-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY745476163W00000X
NY349245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse