Healthcare Provider Details

I. General information

NPI: 1346822699
Provider Name (Legal Business Name): NICHOLAS TSOUKLIDIS MD, MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 HIGH RIDGE RD
STAMFORD CT
06905-1616
US

IV. Provider business mailing address

992 HIGH RIDGE RD
STAMFORD CT
06905-1616
US

V. Phone/Fax

Practice location:
  • Phone: 203-388-8668
  • Fax:
Mailing address:
  • Phone: 203-388-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84366
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: