Healthcare Provider Details

I. General information

NPI: 1649475294
Provider Name (Legal Business Name): NICKOLAOS MICHELAKIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 JERICHO TPKE
MINEOLA NY
11501-1613
US

IV. Provider business mailing address

212 JERICHO TPKE
MINEOLA NY
11501-1613
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-4480
  • Fax: 516-663-2054
Mailing address:
  • Phone: 516-663-4480
  • Fax: 516-663-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number229987
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number229987
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: