Provider Demographics
NPI:1811457989
Name:AXIOTAKIS, NINA MICHELLE (DO)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MICHELLE
Last Name:AXIOTAKIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 19TH ST NW STE 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1638
Mailing Address - Country:US
Mailing Address - Phone:202-417-7568
Mailing Address - Fax:
Practice Address - Street 1:1320 19TH ST NW STE 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1638
Practice Address - Country:US
Practice Address - Phone:202-417-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-23
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022086352084P0804X
MDH00984062084P0804X
DCDO2100017002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry