Provider Demographics
NPI:1861221152
Name:CONSTANTINIDES, ALEXANDRA RACHEL (DNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RACHEL
Last Name:CONSTANTINIDES
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2134
Mailing Address - Country:US
Mailing Address - Phone:973-590-4426
Mailing Address - Fax:
Practice Address - Street 1:1 FARRINGTON LN
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2134
Practice Address - Country:US
Practice Address - Phone:973-590-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF405959-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health