Provider Demographics
NPI:1881410223
Name:CHRISTAKOS, MARIA KALLY
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:KALLY
Last Name:CHRISTAKOS
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 1:413 N MOORE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-3945
Mailing Address - Country:US
Mailing Address - Phone:919-907-9629
Mailing Address - Fax:
Practice Address - Street 1:1021 PINE PLAZA DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-6406
Practice Address - Country:US
Practice Address - Phone:919-331-6047
Practice Address - Fax:919-331-6048
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1690237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist