Provider Demographics
NPI:1811687130
Name:CHRISTAKIS, NATHANIEL CASEY
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:CASEY
Last Name:CHRISTAKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 TRAIL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:COSBY
Mailing Address - State:TN
Mailing Address - Zip Code:37722-2118
Mailing Address - Country:US
Mailing Address - Phone:708-218-3114
Mailing Address - Fax:
Practice Address - Street 1:1139 NIKKI VIEW DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4879
Practice Address - Country:US
Practice Address - Phone:813-879-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist