Provider Demographics
NPI:1538421912
Name:KIRITSIS, THERESA PRIEST (MS)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:PRIEST
Last Name:KIRITSIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2113
Mailing Address - Country:US
Mailing Address - Phone:315-472-4404
Mailing Address - Fax:315-478-2337
Practice Address - Street 1:215 BASSETT ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2113
Practice Address - Country:US
Practice Address - Phone:315-472-4404
Practice Address - Fax:315-478-2337
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist