Healthcare Provider Details

I. General information

NPI: 1811826902
Provider Name (Legal Business Name): MAKENNA KELLY PSINAKIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

200 OLD COUNTRY RD
MINEOLA NY
11501-4235
US

IV. Provider business mailing address

35 JEROME DR
FARMINGDALE NY
11735-1812
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2752
  • Fax:
Mailing address:
  • Phone: 516-404-7800
  • 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 StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: