Provider Demographics
NPI:1205102050
Name:MITSIANIS, ANGELIKI ANASTASIA
Entity type:Individual
Prefix:
First Name:ANGELIKI
Middle Name:ANASTASIA
Last Name:MITSIANIS
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 1:208 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-4638
Mailing Address - Country:US
Mailing Address - Phone:914-886-5220
Mailing Address - Fax:
Practice Address - Street 1:201 E BROAD ST STE C
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3233
Practice Address - Country:US
Practice Address - Phone:864-202-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
SCSLP.7854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist