Provider Demographics
NPI:1912760414
Name:PAPADOPOULOS, DEMETRA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEMETRA
Middle Name:
Last Name:PAPADOPOULOS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15436 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3723
Mailing Address - Country:US
Mailing Address - Phone:718-715-5818
Mailing Address - Fax:
Practice Address - Street 1:2195 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1303
Practice Address - Country:US
Practice Address - Phone:718-715-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034053-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist