Provider Demographics
NPI:1295305589
Name:KRANIOTAKIS, PENELOPE M
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:M
Last Name:KRANIOTAKIS
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 1:196 SCHOLES ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-7809
Mailing Address - Country:US
Mailing Address - Phone:917-683-2619
Mailing Address - Fax:
Practice Address - Street 1:196 SCHOLES ST APT 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-7809
Practice Address - Country:US
Practice Address - Phone:917-683-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174N00000X
NY
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174N00000XOther Service ProvidersLactation Consultant, Non-RN