Provider Demographics
NPI:1831391333
Name:STAGIAS- COULIANIDIS, NICOLETTA (MA, CCC- SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLETTA
Middle Name:
Last Name:STAGIAS- COULIANIDIS
Suffix:
Gender:F
Credentials:MA, CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 168TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1512
Mailing Address - Country:US
Mailing Address - Phone:718-358-3162
Mailing Address - Fax:
Practice Address - Street 1:2532 168TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1158
Practice Address - Country:US
Practice Address - Phone:718-939-0306
Practice Address - Fax:718-939-0314
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist