Healthcare Provider Details

I. General information

NPI: 1053171751
Provider Name (Legal Business Name): JACQUELINE NIKAKIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 S COMPASS WAY
DANIA BEACH FL
33004-2368
US

IV. Provider business mailing address

1 HEROES WAY
RIVERHEAD NY
11901-2054
US

V. Phone/Fax

Practice location:
  • Phone: 954-807-9433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: