Healthcare Provider Details

I. General information

NPI: 1730543380
Provider Name (Legal Business Name): DESPINA TSEVDOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 56TH ST
BROOKLYN NY
11220-2510
US

IV. Provider business mailing address

126 56TH ST
BROOKLYN NY
11220-2510
US

V. Phone/Fax

Practice location:
  • Phone: 917-725-0787
  • Fax:
Mailing address:
  • Phone: 917-725-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number298185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: